Case Report
Rituximab for the treatment of the skin manifestations of dermatomyositis: A report of 3 cases

https://doi.org/10.1016/j.jaad.2006.05.068Get rights and content

Three patients suffering from classic dermatomyositis (juvenile and adult-onset) with prominent recalcitrant skin manifestations are described. All patients demonstrated good control of muscle symptoms on immunosuppressive medications, but their cutaneous disease persisted despite treatment with at least 4 different systemic treatments and topical agents. They were given rituximab, a monoclonal anti-CD20 antibody, achieving a response with minimal side effects. We document our experience with this medication for the cutaneous lesions of dermatomyositis.

Section snippets

Case 1

A 22-year-old woman was referred with an 8-year history of juvenile-onset classic DM complicated by mild interstitial lung disease. She demonstrated mechanics' hands (palmar hyperkeratosis) and long-standing poikilodermatous changes on her back and shoulders with violaceous erythema, postinflammatory hyperpigmentation, and superficial atrophy. Skin biopsy findings were consistent with DM. She had not complained of muscle symptoms for several years; her cutaneous lesions were the focus of

Discussion

DM is believed to be humorally mediated with activation of the complement system, resulting in deposition of the membrane attack complex in the capillaries of patients.12 Although the role of B cells in the development of DM has not been clearly established, the inflammatory infiltrates in the muscles of patients with DM have demonstrated more perivascular B lymphocytes than endomysial T lymphocytes.13 Indeed, the depletion of B cells by rituximab does closely parallel improvement in the muscle

References (27)

  • E.F. Chakravarty et al.

    Rheumatic syndromes associated with malignancy

    Curr Opin Rheumatol

    (2003)
  • T.D. Levine

    Rituximab in the treatment of dermatomyositis: an open-label pilot study

    Arthritis Rheum

    (2005)
  • D.G. Moloney et al.

    Rituximab: mechanism of action and resistance

    Semin Oncol

    (2002)
  • Cited by (80)

    • Emerging therapeutics in the management of connective tissue disease. Part II: Dermatomyositis and scleroderma

      2022, Journal of the American Academy of Dermatology
      Citation Excerpt :

      Abatacept, a fusion protein composed of IgG1 fused to the extracellular domain of cytotoxic T-lymphocyte associated protein-4 approved for rheumatoid arthritis, has shown mild efficacy for both juvenile and adult patients with DM. Previous cases have demonstrated improvement in skin disease in both juvenile and adult patients with DM who were treated with rituximab.24-26 However, a pilot study of 8 patients found no significant change in cutaneous disease via the Dermatomyositis Skin Severity Index.27

    • Dermatomyositis: Diagnosis and treatment

      2020, Journal of the American Academy of Dermatology
    View all citing articles on Scopus

    Funding sources: None.

    Conflicts of interest: None identified.

    View full text