title: A comparative study of clinical characteristics, work-up, treatment, and association to malignancy in dermatomyositis between two tertiary skin centers in the USA and Singapore.
abstract: BACKGROUND
  To date, no study has compared the clinical characteristics, malignancy associations, and treatment of dermatomyositis in predominantly Caucasian vs. Asian populations.
  
  
  METHODS
  This prospective study was conducted to compare clinical characteristics of dermatomyositis, its relationship to malignancy, and treatment between two tertiary medical centers in the USA and Singapore. A total of 19 newly-diagnosed patients in the USA and 15 patients in Singapore were enrolled. Dermatomyositis or amyopathic dermatomyositis were diagnosed based on clinical assessment, skin and muscle biopsies, and muscle testing.
  
  
  RESULTS
  Ninety-five percent of patients in the USA group were of Caucasian descent, while 93% of patients in the Singapore group were of Chinese descent. Both groups were predominantly female. Pruritus was the most common initial symptom reported in both groups, while periungual erythema and Gottron's papules were the most common skin presentations. Heliotrope eruption was more common in the Singapore group, occurring in 80% of patients vs. 32% of patients in the USA group (P = 0.007). Three patients in the Singapore group developed a malignancy, with two of these patients having nasopharyngeal carcinoma. None of the USA patients developed malignancies in a follow- up period of 2-5 years. Immunosuppressive steroid sparing therapy with hydroxychloroquine was more frequently used in Singapore, while topical tacrolimus was more frequently used in the USA.
  
  
  CONCLUSIONS
  The clinical presentations of dermatomyositis vary among different ethnic populations. Chinese patients with dermatomyositis have a significant risk for nasopharyngeal carcinoma.
authors: Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-0001, USA. gyosipov@wfubmc.edu
authors: Gil
authors: G
authors: Yosipovitch
authors: Audrey
authors: A
authors: Tan
authors: Katherine
authors: K
authors: LoSicco
authors: Catherine G
authors: CG
authors: Manabat
authors: Ajith
authors: A
authors: Kannagra
authors: Christie
authors: C
authors: Carroll
authors: Yiong Huak
authors: YH
authors: Chan
authors: Patricia
authors: P
authors: Ng
authors: Joseph
authors: J
authors: Jorizzo
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D044466:Asian People; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D017610:Calcium Compounds / Q000627:therapeutic use; D002277:Carcinoma / Q000150:complications*; D003882:Dermatomyositis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D019587:Dietary Supplements; D004164:Diphosphonates / Q000627:therapeutic use; D004890:Erythema / Q000209:etiology; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D009303:Nasopharyngeal Neoplasms / Q000150:complications*; D010087:Oxides / Q000627:therapeutic use; D011446:Prospective Studies; D011537:Pruritus / Q000209:etiology; D000069283:Rituximab; D012846:Singapore; D016559:Tacrolimus / Q000627:therapeutic use; D062606:Tertiary Care Centers; D014481:United States; D014807:Vitamin D / Q000627:therapeutic use; D044465:White People
chemical_list: D000305:Adrenal Cortex Hormones; D058846:Antibodies, Monoclonal, Murine-Derived; D050071:Bone Density Conservation Agents; D017610:Calcium Compounds; D004164:Diphosphonates; D007166:Immunosuppressive Agents; D010087:Oxides; D014807:Vitamin D; D000069283:Rituximab; D006886:Hydroxychloroquine; C016538:lime; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008727:Methotrexate