minocycline and Dermatomyositis

Calcinosis, insoluble calcium compounds deposited in skin and other tissues, is a crippling sequela of dermatomyositis. Prolonged disease associated with ongoing inflammation, ischemia, repetitive trauma, and certain autoantibodies are associated with calcinosis. Herein, we describe potential pathogenic mechanisms including the role of mitochondrial calcification. There are no widely effective treatments for calcinosis. We review available pharmacologic therapies for calcinosis including those targeting calcium and phosphorus metabolism; immunosuppressive/anti-inflammatory therapies; and vasodilators. Mounting evidence supports the use of various formulations of sodium thiosulfate in the treatment of calcinosis. Although the early institution of aggressive immunosuppression may prevent calcinosis in juvenile dermatomyositis, only limited data support improvement once it has developed. Minocycline can be useful particularly for lesions associated with surrounding inflammation. Powerful vasodilators, such as prostacyclin analogs, may have promise in the treatment of calcinosis, but further studies are necessary. Surgical removal of lesions when amenable is our treatment of choice.

Topics: Anti-Inflammatory Agents; Autoantibodies; Calcinosis; Calcium; Dermatomyositis; Humans; Inflammation; Minocycline; Phosphorus; Prostaglandins I; Vasodilator Agents

Calcinosis cutis constitutes a heterogeneous group of chronic disorder. It can be associated with disturbance of calcium and/or phosphate metabolism (metastatic, tumor calcinosis, calciphylaxis) but may also develop without any metabolic disorder, in particular during the course of connective tissue diseases. Among these, the most common are dermatomyositis and the limited form of systemic sclerosis. The physiopathology of calcinosis cutis is poorly known. It can cause pain, chronic ulcerations, infections, which are sources of sometimes major disability. Treatment of calcinosis is challenging because no drug has been shown to be reliably effective in stopping the progression or decreasing dystrophic calcifications in controlled trials. Calcium blocker and colchicine are generally prescribed as the first line systemic therapy. In the localized forms of small lesions, surgical excision is often effective and sometimes preceded by local treatments (laser therapy, extracorporeal shock wave lithotripsy, topical sodium thiosulfate, etc.) or systemic treatment (minocycline, warfarine). When calcinosis is disseminated, it may require additional treatments (aluminium hydroxyde, bisphosphonates) possibly associated with surgery in case of large lesions. Time to response may be prolonged from weeks to months. The calcinosis cutis can lead to secondary infection, pain and functional disability that have to be prevented.

Topics: Calcinosis; Calcium Channel Blockers; Colchicine; Dermatomyositis; Humans; Minocycline; Scleroderma, Systemic; Warfarin

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Dermatomyositis; Humans; Lung Neoplasms; Male; Methylprednisolone; Middle Aged; Minocycline; Pyoderma Gangrenosum; Small Cell Lung Carcinoma

Minocycline is a semisynthetic tetracycline that causes a spectrum of autoimmune adverse reactions. We report a previously healthy patient who developed a panniculitis and histopathologically proven dermatomyositis during treatment with minocycline for acne vulgaris. Her signs and symptoms resolved completely upon cessation of minocycline. This case illustrates a novel adverse effect of a widely prescribed medication.

Topics: Dermatomyositis; Female; Humans; Minocycline; Young Adult

Topics: Aged; Anti-Bacterial Agents; Dermatomyositis; Humans; Male; Minocycline; Pemphigoid, Bullous

Topics: Aged; Anti-Bacterial Agents; Anti-Infective Agents; Ciprofloxacin; Clarithromycin; Dermatomyositis; Drug Resistance, Microbial; Female; Humans; Minocycline; Mycobacterium chelonae; Mycobacterium Infections, Nontuberculous