Review
Dermatomyositis induced by drug therapy: A review of case reports

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Background

Drugs have occasionally been implicated in dermatomyositis (DM) onset.

Objective

We sought to review case reports of drug-induced DM.

Methods

Articles were gathered from MEDLINE and bibliographies of acquired reports. Causality was assessed using World Health Organization criteria. Clinical characteristics, management, and resolution were examined.

Results

In 70 reported cases, 50% of patients were female and the median age was 57 years. Hydroxyurea was implicated in 51% of cases. All cases had pathognomonic (76%) or compatible (24%) cutaneous findings. Hydroxyurea cases lacked myositis, but myositis was described in 79.4% of nonhydroxyurea cases. Drug causality was probable (25.7%) or possible (74.3%), but not certain in any case. Most patients had underlying pathology associated with DM (44% had malignancy; 16% had rheumatoid arthritis). Of the sample, 84.3% had improvement of DM after discontinuation of the drug.

Limitations

Case reports may emphasize unusual findings.

Conclusions

Further work is needed to differentiate drug effects from underlying, predisposing factors.

Section snippets

Literature search and search terms

The MEDLINE database was searched for literature published from 1950 through the first week of July 2007. Articles were gathered using the Medical Subject Headings term “dermatomyositis,” limited to English language, with the attached subheading “chemically induced.” We searched the resulting articles for case reports. There were 36 articles from this search that included case reports. Then, MEDLINE in-process and other nonindexed citations were searched through July 13, 2007 (which yielded an

Case reports

We identified 50 potentially relevant articles by searching MEDLINE and identified an additional 16 by reviewing the bibliographies of retrieved articles. Of these, 47 articles met inclusion criteria. The total number of case reports in these articles that were included in the analysis was 70. Articles were eliminated for the following reasons: 11 articles did not include a case report but were descriptive instead; 4 articles described cases with cutaneous findings that were of clinical

How may drug-induced DM be diagnosed?

The cutaneous manifestations described in the cases were mostly pathognomonic and/or consistent with DM. The skin pathology was also mostly classic, although skin pathology alone cannot distinguish DM from cutaneous lupus erythematosus.1 To assist with the diagnosis of DM and differentiating it from cutaneous lupus erythematosus, cases may be evaluated for presence of pruritus (more typical in DM than cutaneous lupus erythematosus)1 and proximal muscular weakness. Evaluation of muscular

Conclusions

Drug-induced DM is rare. Hydroxyurea appears to be the most common inciting agent, mostly in the context of treating CML. Patients taking hydroxyurea tend to have late onset (>2 months) of DM, and they lack myositis. The majority of cases of drug-induced DM improve after withdrawal of the medication thought to play a role. If the clinical possibility of drug-induced DM is encountered, drug discontinuation may not only help alleviate DM, but may also serve as a dechallenge test, whereby DM

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    Supported by a generous grant from Ms Joan Fabry.

    Disclosure: Dr Seidler received a research/educational grant from Stiefel. Dr Gottlieb (all income paid to employer directly) is a member of the speaker's bureaus of Amgen Inc and Wyeth Pharmaceuticals; has current consulting/advisory board agreements with Amgen Inc, Centocor Inc, Wyeth Pharmaceuticals, Celgene Corp, Bristol Myers Squibb Co, Beiersdorf Inc, Warner Chilcott, Abbott Labs, Roche, Sankyo, Medarex, Kemia, Celera, TEVA, Actelion, UCB, Novo Nordisk, Almirall, Immune Control, RxClinical, Dermipsor Ltd, Medacorp, DermiPsor, Can-Fite, and Incyte; and has research/educational grants from Centocor, Amgen, Wyeth, Immune Control, Abbott, Pharmacare, Incyte, Celgene, and Roche.

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