Combination antimalarials in the treatment of cutaneous dermatomyositis - A retrospective study

Objective: To observe whether the use of antimalarials in combination resulted in significant improvement in the cutaneous signs and symptoms of patients with dermatomyositis who did not other-wise respond to the use of single-agent antimalarial therapy. Design: Retrospective case series of 17 patients treated between January 1, 199 1, and December 31, 2002. Setting: An ambulatory medical dermatology clinic in an academic center. Patients: Patients had adult-onset dermatomyositis with predominantly cutaneous symptoms and a follow-up period at our clinic of at least 6 months. Cases in which it was not possible to assess the effect of treatment on cutaneous symptoms were not included. Intervention: Treatment regimens varied and included the use of antimalarials, prednisone, methotrexate, and other medications. Main Outcome Measures: Physician-observed and patient-reported improvement based on erythema, pruritus, and extent of affected skin. Results: Seven of 17-patients experienced at least near clearance in cutaneous symptoms with the use of antimalarial therapy alone: 4 of these patients required combination therapy (hydroxychloroquine sulfate-quinacrine hydrochloride or chloroquine phosphatequinacrine), while 3 of them responded well to antimalarial monotherapy. The median time required to reach the response milestones on the final working therapeutic regimen was 3 months (mean, 4.8 months; range, 2-14 months). Six patients did not respond significantly to any type of therapy, including nonantimalarials. Conclusion: Our experience suggests that a significant subgroup of patients whose skin lesions have been unresponsive to a single antimalarial benefit from combination therapy with hydroxychloroquine and quinacrine or chloroquine and quinacrine, but controlled clinical trials are warranted to assess the extent of benefit.