Treatment of recalcitrant dermatomyositis with efalizumab.

Sir, Dermatomyositis (DM) is an auto-immune disease that primarily affects muscles and skin. Muscle weakness appears in the shoulders and hips in particular. Skin symptoms include a diffuse violaceous erythema and oedema, predominantly of the upper face including the orbita, and violaceous-red papules of the finger (Gottron papules). The pathogenesis of DM is unclear, but recent studies suggest a central role of auto-aggressive lymphocytes and type I interferons (1–4), as has been proposed earlier for cutaneous lupus erythematosus (5–7). Corticosteroids are the established first-line treatment for DM. However, their use is limited because of sideeffects. Unfortunately, recalcitrant courses exist that respond poorly to corticosteroids and to other immunomodulatory and immunosuppressive drugs (8).