What are the other Names for this Condition? (Also known as/Synonyms)

• Dermatomyositis-Associated Flagellate Erythema
• Flagellate Erythema due to Dermatomyositis
• Flagellate Erythema in Dermatomyositis

What is Dermatomyositis-Induced Flagellate Erythema? (Definition/Background Information)

• Dermatomyositis-Induced Flagellate Erythema is an uncommon skin condition that occurs against a background of dermatomyositis, an inflammatory disorder that results in muscle weakening along-with the appearance of skin rashes
• Flagellate erythema is an uncommon skin rash that has a specific linear streak pattern. The pattern resembles flagellation - as though the individual has been beaten by a whip (or whiplashed)
• Dermatomyositis-Induced Flagellate Erythema may be seen in both children and adults. It is believed that the itchy skin rash develops secondary to dermatomyositis, as an abnormal immune response by the body
• The skin rashes in Dermatomyositis-Induced Flagellate Erythema may occur on the back, chest, or arms and legs. The signs and symptoms of dermatomyositis may include painful, itchy rashes, and progressive weakening of the muscles. It can result in the formation of hardened lumps of calcium under the skin
• Adequate treatment of the underlying dermatomyositis may help mitigate the skin rashes. In some individuals, symptomatic treatment, using steroid medications or laser therapy for flagellate erythema, may be necessary
• The prognosis of Dermatomyositis-Induced Flagellate Erythema is good in a majority of cases, with early treatment. However, the overall prognosis also depends on the underlying cause and its severity

Who gets Dermatomyositis-Induced Flagellate Erythema? (Age and Sex Distribution)

• Dermatomyositis-Induced Flagellate Erythema may occur at any age; although, adults are affected the most
• Both males and females may be affected. Dermatomyositis, in general, shows a female predominance
• Individuals of all racial and ethnic background can be affected

What are the Risk Factors for Dermatomyositis-Induced Flagellate Erythema? (Predisposing Factors)

• Individuals with dermatomyositis are at an increased risk for developing Dermatomyositis-Induced Flagellate Erythema

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Dermatomyositis-Induced Flagellate Erythema? (Etiology)

• Research scientists believe that Dermatomyositis-Induced Flagellate Erythema is caused by an immunological response of the body to dermatomyositis. The characteristic skin rashes form as a reaction to the underlying condition
• Dermatomyositis is a longstanding inflammatory disorder of the muscles that results in characteristic skin rashes on the body. The exact cause of the condition is unknown, but it is believed to develop due to viral infections, immune system dysfunction, or an underlying cancer
• There are other causes of flagellate erythema such as prior administration of bleomycin and adult onset Still’s disease
• It is researched that flagellate erythema is not a disorder in itself; rather, a manifestation of a systemic condition that occurs secondary to the associated dermatomyositis
• The appearance of the skin lesion correlates with the disease activity; meaning that increased dermatomyositis activity, increases the chances of getting such rashes

What are the Signs and Symptoms of Dermatomyositis-Induced Flagellate Erythema?

The signs and symptoms of Dermatomyositis-Induced Flagellate Erythema include:

• The itchy (pruritic) rash occurs as red whiplash-like streak on any part of the body skin. The rash may also take the following forms:
  • Zebra-like stripe eruptions
  • Linear streaks due to flagellate erythema
  • Centripetal flagellate erythema
• Scratching and rubbing the area may make the condition worse, resulting in bleeding
• The rashes occur usually on the back and flank region (trunk or chest) and on the extremities
• Additionally, the symptoms of dermatomyositis may include progressive weakening of the muscles, formation of lumps beneath the skin, fatigue, swallowing difficulties, and voice change

How is Dermatomyositis-Induced Flagellate Erythema Diagnosed?

A diagnosis of Dermatomyositis-Induced Flagellate Erythema may involve the following:

• A thorough medical history assessment and complete physical examination
• Assessment of the signs and symptoms
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Blood tests to check for the levels of two muscle enzymes types - creatine phosphokinase and aldolase; as well as, to check for antibodies that attack healthy/normal cells (autoantibodies)
• Imaging studies, such as MRI scan, to detect muscle abnormalities
• EMG (electromyography), to record electrical impulses that control the muscles
• Skin or muscle biopsy: A skin/muscle biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Dermatomyositis-Induced Flagellate Erythema?

The complications of Dermatomyositis-Induced Flagellate Erythema may include:

• Change in skin pigmentation
• Cosmetic issues that result in emotional stress
• Bleeding and ulceration of the skin may result in secondary viral or bacterial infections
• Complications due to dermatomyositis that may include chronic muscle pain, weakness, aspiration pneumonia, malnutrition, including involvement of the heart and lungs
• Recurrence of the skin rashes

How is Dermatomyositis-Induced Flagellate Erythema Treated?

The treatment options of Dermatomyositis-Induced Flagellate Erythema include treating the symptoms of the underlying dermatomyositis, since it is incurable. Appropriate therapy may help in improving the skin appearance and muscle strength, which is undertaken through:

• Administration of oral or topical corticosteroids
• Physical therapy and speech therapy
• Administration of intravenous immunoglobulin (IVIG)
• Surgery to remove calcium deposits
• Symptomatic and supportive therapy, if needed

Typically, symptomatic treatment is provided for flagellate erythema, if necessary, which may include:

• Topical steroid creams and oral steroids for itchy skin
• Cooling the area of the rash can be helpful
• Skin hyperpigmentation can be treated using laser therapy, if it causes significant cosmetic concerns

How can Dermatomyositis-Induced Flagellate Erythema be Prevented?

Currently, there are no known methods to prevent the occurrence of Dermatomyositis-Induced Flagellate Erythema. However, one may lower the risk for the skin condition by considering the following factors:

• Treating dermatomyositis early and adequately
• Inform your physician if you are allergic to certain medications
• Aggravation of dermatomyositis may be prevented through avoiding sun exposure, using sunscreen, and wearing suitable protective clothing

What is the Prognosis of Dermatomyositis-Induced Flagellate Erythema? (Outcomes/Resolutions)

• The prognosis for Dermatomyositis-Induced Flagellate Erythema is usually good with prompt treatment of dermatomyositis
• However, the overall prognosis is dependent on the underlying skin disorder, the severity of the symptoms presented, and the health status of the individual
• Individuals who respond well to treatment have a better prognosis than individuals who do not respond well to treatment

Additional and Relevant Useful Information for Dermatomyositis-Induced Flagellate Erythema:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse