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Dermatomyositis

A rare autoimmune disease that inflames the muscles and skin, causing weakness in the hips, thighs, shoulders and neck and a distinctive purple-red rash. It affects adults and children. There is no cure, but treatment and exercise can bring it under control and many people reach remission.

What is dermatomyositis?

Dermatomyositis (DM) is one of the inflammatory myopathies, a group of rare diseases that cause long-lasting muscle inflammation and weakness in children and adults (NINDS). It is an autoimmune disease: the immune system attacks the body’s own tissues (NINDS). In DM, inflammation of the blood vessels under the skin and in the muscles causes both the rash and the weakness (The Myositis Association). Its cause is unknown (Johns Hopkins Myositis Center); genes, the immune system and things in the environment, such as infections, are thought to play a part (NORD).

How common is it, and who gets it?

Symptoms

Get help fast for these.

  • Trouble breathing, or trouble swallowing or choking on food or drink: go to the emergency room (Cleveland Clinic). Weak chest and breathing muscles can cause life-threatening breathing problems without prompt treatment (NORD), and food or fluid that goes “down the wrong pipe” can cause pneumonia (TMA).
  • New or worsening shortness of breath or a dry cough: contact your doctor right away. These can be signs of lung inflammation, which usually progresses slowly but can turn into breathing distress quickly (TMA). If you take methotrexate, call your doctor immediately for a dry cough, fever, difficulty breathing or shortness of breath (MedlinePlus).
  • New weakness, or weakness that is getting worse or spreading: see a doctor right away. Dermatomyositis can be fatal if it isn’t treated as soon as possible (Cleveland Clinic).
  • Fever, chills, sore throat, cough or other signs of infection while taking immune-suppressing medicine: call your doctor promptly. These medicines raise the risk of serious infection and can blunt or delay a fever (TMA, MedlinePlus).

Cancer risk in adults

Adult-onset myositis is linked with a higher risk of cancer in the three years before and after it begins (IMACS guideline, 2023), and this link is strongest in dermatomyositis (TMA). Cancers of the digestive tract, lung, breast, ovary and lymph system are among those seen (NORD). Risk is higher in people over 45, those with a past or family history of cancer, and those with certain antibodies (anti-TIF1-γ or anti-NXP2); after five years the risk falls back to that of the general population (TMA). Cancer is rare in children with JDM (NORD).

Screening matters. A 2023 international guideline sorts each adult into standard, moderate or high risk and recommends a “basic” screening panel (including a chest X-ray and blood tests) or an “enhanced” panel (including CT scans), with endoscopy or PET-CT for some people (IMACS guideline, 2023). Ask your doctor which plan fits you (Cleveland Clinic). When a cancer is found and treated, the dermatomyositis often improves (NORD), but it still needs its own treatment (TMA). See our cancer guide for more on screening and care.

Lung disease and other complications

  • Interstitial lung disease (ILD) — inflammation and scarring of lung tissue — is the most common serious complication of myositis; researchers estimate 30–40% of people with myositis have some lung disease. It can come before the muscle symptoms and can be severe even when the skin and muscles seem mild. Certain antibodies, including anti-MDA5, are linked to it (TMA).
  • Calcinosis — hard lumps of calcium in or under the skin — affects as many as 70% of children with JDM and about 20% of adults with myositis. The lumps can be painful, limit movement and cause skin sores (ulcers) (TMA).

Juvenile dermatomyositis

JDM is similar to the adult form, but it usually starts more suddenly, and calcinosis and inflammation of the blood vessels in the gut are more common (NORD). The first sign is usually a rash; children may struggle to climb stairs or get onto a bus, fall more often, or have a weaker voice or trouble swallowing (TMA), and low-grade fevers, often at night, can occur (Cure JM). Pediatric rheumatologists usually lead care (Cure JM).

How it’s diagnosed

Not every doctor is familiar with this rare disease, so a specialist can help (TMA). It can be mistaken for other skin or autoimmune conditions, such as lupus (Cleveland Clinic). Besides an exam for the typical rash and weakness, diagnosis usually uses:

What to expect over time

There is no cure (TMA), but treatment can often put myositis into remission (Cleveland Clinic), and symptoms often improve within a few months of starting it (Cleveland Clinic). Without enough treatment it can cause serious disability (TMA). Some adults respond completely and can slowly come off medicine under close watch; others need long-term treatment (NORD). For children, outcomes have kept improving: many reach remission or are well controlled on moderate maintenance treatment, though some have a longer course (Cure JM).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Care led by a rheumatologist (often with a dermatologist, lung specialist and therapists). Corticosteroids first, then steroid-sparing immunosuppressants (methotrexate, azathioprine, mycophenolate); IVIG (an IVIG product, Octagam, is FDA-approved for adult DM), rituximab, and the newly approved oral drug brepocitinib for harder cases; hydroxychloroquine and skin creams for the rash; sun protection; physical therapy; bone protection; cancer and lung screening. IVIG is very expensive; drug prices: cost estimate being researched. Medicare drug coverage caps out-of-pocket costs at $2,100 in 2026. Physical therapy about $50–$350+ a session without insurance. No cure, but symptoms often improve within months and many people reach remission. Steroid side effects, infections and cancer screening need ongoing attention.
Chiropractic No role in treating dermatomyositis, which is an autoimmune disease of the muscles and skin. Not applicable — not a recommended treatment. Long-term steroids can thin the bones, so tell any chiropractor about your diagnosis, medicines and any osteoporosis; a physical therapist is the right guide for exercise.
Acupuncture Being researched — coming soon.
Herbal medicine No herb or supplement is proven to treat dermatomyositis. Calcium, vitamin D or folic acid may be advised by your doctor alongside certain medicines. Not applicable — not a recommended treatment. “Immune-boosting” herbs such as echinacea or cat’s claw may work against treatment or interact with immunosuppressants. Check with your doctor or pharmacist first.
Massage therapy Gentle massage for relaxation and stress relief only, avoiding rashes, calcium lumps and fragile skin. About $60–$120 for 45–60 minutes with a private therapist, or $50–$90 at clinics, gyms and spas. No dermatomyositis-specific research. Generally low-risk, but use light pressure if steroids have thinned your bones, and ask your doctor first.
MBHA Wellness Coach Following your physical therapist’s exercise plan, strict sun protection, pacing fatigue, safer swallowing, steroid-friendly nutrition, infection prevention, support groups and school plans for children. Cost estimate being researched. TMA support groups are free to join. Supports — never replaces — your rheumatology team. Good habits help you get the most from treatment and spot problems early.

Approach 1 of 6

Conventional medicine (AMA)

Treatment aims to calm the inflammation, restore strength and protect the skin, lungs and other organs. It is tailored to each person, and some trial and error is often needed (TMA). Most of the medicines used are approved for other conditions and used “off label” in myositis, based on research and expert experience (TMA). We don’t list doses; your doctors will tailor any medicine to you.

Your care team

A dermatomyositis team may include rheumatologists, dermatologists, lung specialists (pulmonologists), physical and occupational therapists, and speech-language pathologists (Cleveland Clinic). Children are usually cared for by pediatric rheumatologists (Cure JM).

Medicines

  • Corticosteroids such as prednisone are the usual first treatment; they work fairly quickly to calm inflammation, ease pain and improve strength, and the dose is lowered slowly over months as symptoms improve (TMA, NORD). Never stop or cut steroids on your own — the taper must be gradual (TMA).
  • Steroid-sparing immunosuppressants — methotrexate, azathioprine and mycophenolate, among others — are added to control the disease and let the steroid dose come down, which means fewer steroid side effects (NORD, TMA). The choice depends partly on your symptoms — for example, methotrexate may not suit people with lung disease — and all of them raise the risk of infection (TMA).
  • Intravenous immune globulin (IVIG), made from donated plasma, is given by infusion (TMA). In 2021 the FDA approved an IVIG product (Octagam) for dermatomyositis in adults (FDA approval letter, 2021, FDA). The approval was based on the ProDERM trial of 95 adults: after 16 weeks, 79% of people on IVIG had at least minimal improvement compared with 44% on placebo. Side effects included headache, fever and nausea, and a few serious reactions included blood clots (Aggarwal et al., NEJM, 2022). IVIG is often especially helpful for stubborn skin symptoms and lung disease (TMA).
  • Rituximab, a biologic given by infusion, is one of the most frequently used biologics when other treatments haven’t worked, though it is not FDA-approved specifically for myositis (TMA).
  • Brepocitinib (Lisraya), a once-daily JAK inhibitor tablet, was approved by the FDA in August 2026 as the first oral drug for dermatomyositis in adults. In a year-long trial of 241 adults it improved overall disease activity, physical function and skin disease more than placebo, and more people were able to reduce steroids. It carries a boxed warning for serious infections, death from any cause, cancers, major heart and blood-vessel events, and blood clots (FDA, August 2026).
  • For the skin: sun avoidance and sunscreen, steroid creams, and antimalarial medicines such as hydroxychloroquine, as well as methotrexate, mycophenolate or IVIG (NORD).

Exercise and therapy are part of treatment

It’s natural to worry that exercise will harm weak, painful muscles, but exercise and physical therapy are important parts of standard myositis treatment: all exercise studies in myositis confirm its safety, and exercise can reduce inflammation and fatigue and improve stamina and strength (TMA). A 2022 review of 19 studies found that exercise in DM and polymyositis is probably safe at all ages and moderately improves strength and aerobic capacity, with no flares reported (da Silva et al., Clin Rheumatol, 2022). Evidence is still thin for people who are newly diagnosed (Alexanderson and Boström, 2020), so let a physical therapist set the pace. Physical, occupational and speech therapy may all be recommended (Cleveland Clinic), and physical therapy helps prevent stiff, bent joints (contractures) (NORD).

Protecting your bones and body on steroids

Long-term steroids can cause brittle bones (osteoporosis), cataracts and glaucoma, diabetes, weight gain and mood changes, and can affect growth in children (TMA); they can also raise blood pressure and cause steroid-related muscle weakness (NORD). Doctors may check bone density, blood sugar, blood pressure and eye pressure, and calcium and vitamin D are usually recommended (TMA, NORD).

If you have lung disease, your rheumatologist and lung specialist should plan care together, with regular breathing tests and scans (TMA).

What it costs

  • IVIG is very expensive, which is one reason it is usually kept for disease that doesn’t respond to other treatments (TMA). Rituximab and brepocitinib: cost estimate being researched.
  • Help paying: with Medicare drug coverage, out-of-pocket costs for covered Part D drugs are capped at $2,100 in 2026 and $2,400 in 2027, and Extra Help is available for people with limited income (Medicare.gov). Patient assistance programs can help when you have trouble paying for prescriptions (TMA); ask your clinic’s financial counselor or the drug maker about programs.
  • Physical therapy: about $50–$350 or more a session without insurance, or a $10–$75 copay or 10%–50% coinsurance with it (CostHelper). Medicare Part B covers medically necessary outpatient therapy, with no yearly cap on what Medicare pays (Medicare.gov).
  • Specialist visits, scans and screening tests: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating dermatomyositis. The weakness and rash come from immune inflammation in the blood vessels of the muscles and skin (TMA), which is treated with medicines that calm the immune system (TMA). The Myositis Association lists chiropractic among mind and body practices but knows of no studies of these practices in myositis (TMA).

Safety if you see a chiropractor for something else

  • Long-term steroid treatment can cause brittle bones (osteoporosis) (TMA). Serious problems after spinal manipulation are rare, but the risk may be greater in people with underlying health problems that raise their risk of injury, so tell the practitioner about your health conditions and medicines (NCCIH).
  • MBHA suggests avoiding high-velocity adjustments if you have osteoporosis or take long-term steroids, and getting your rheumatologist’s advice first.
  • For strength and movement, a physical therapist who understands myositis is the right guide (TMA).

Find a chiropractor in our directory

Approach 4 of 6

Herbal medicine

We found no herb or supplement proven to treat dermatomyositis. A 2026 review of nutrition studies in muscle diseases found the evidence limited, especially for inflammatory myopathies. In polymyositis and DM, creatine combined with exercise improved high-intensity physical performance over six months (Talreja et al., Rheumatology, 2026). Talk with your doctor before trying it.

Supplements your doctor may recommend

Some supplements support treatment rather than treat the disease: calcium and vitamin D for people on steroids, and folic acid for people taking methotrexate (TMA, NORD). Your doctor will tell you whether you need them.

Be careful with “immune boosters”

  • Echinacea is promoted on the idea that it may stimulate the immune system, and there are theoretical reasons to suspect it might interact with immunosuppressants (NCCIH).
  • Cat’s claw might make the immune system more active, which could increase symptoms of autoimmune diseases, and may interact with immunosuppressants (NCCIH).
  • Asian ginseng may worsen autoimmune disorders, and St. John’s wort has documented interactions with the immunosuppressant cyclosporine (NCCIH), which is sometimes used in myositis (TMA).
  • What’s on a supplement label may not be what’s in the product; the FDA has found hidden prescription drugs in some products (NCCIH).

Before you take any supplement, show it to your rheumatologist or pharmacist — supplements may interact with your medicines (NCCIH). Always take your prescribed medicines as directed and never stop or change them without your doctor (TMA). We don’t list doses here.

Approach 5 of 6

Massage therapy

There is no research on massage for dermatomyositis, and it does not treat the inflammation. The Myositis Association lists massage among the approaches some members find helpful for stress, while noting it knows of no studies in myositis (TMA).

The risk of harm from massage appears low, but rare serious problems, including blood clots, nerve injury and bone fractures, have been reported, sometimes with vigorous or deep-tissue work or in people at higher risk of injury (NCCIH). As a precaution, MBHA suggests:

  • Ask your doctor first, especially during a flare or if you have osteoporosis from steroids (TMA).
  • Choose light pressure, and skip areas with rash, broken skin or calcium lumps, which can be painful and cause skin sores (TMA).
  • The DM rash is often itchy (NORD); if your skin is irritated, ask for a fragrance-free lotion or none at all.

What it costs

About $60–$120 for 45–60 minutes with a private therapist, or $50–$90 at clinics, gyms and spas (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you turn your care team’s advice into daily habits — alongside, never instead of, your medical care.

Exercise, guided by a physical therapist

Get your doctor’s clearance, then work with a physical therapist who understands myositis to build a plan that fits you; walking at your own pace is always safe (TMA). Start gently and build up slowly; during a severe flare it may be best to stick to everyday movement and walking. Exercise can raise CK levels, so tell your doctor about your routine before blood tests (TMA). A coach can help you stick with the plan.

Sun protection, every day

Sun exposure, even briefly, can make DM skin symptoms flare (TMA), and children with JDM can be sensitive even to indoor fluorescent light (Cure JM). Dermatologists recommend seeking shade, wearing a long-sleeved shirt, pants, a wide-brimmed hat and UV-blocking sunglasses (UPF-labeled clothing protects best), and using a broad-spectrum, water-resistant sunscreen with SPF 30 or higher, reapplied every two hours or after swimming or sweating (American Academy of Dermatology). TMA members add sunscreen year-round, even indoors, and window coverings, since UV passes through glass (TMA).

Pacing fatigue

If you feel overly tired or sore the next day, you’ve done too much; on off days, keep a lighter routine rather than stopping altogether (TMA). Stress and poor sleep can trigger flares, so relaxation techniques and good sleep habits are worth building in (TMA).

Safer swallowing

If you cough or choke when eating, or your voice sounds wet after drinking, ask for an evaluation by a speech-language pathologist, who can teach techniques such as tucking the chin when swallowing and suggest food textures (TMA). Raising the head of the bed and not eating right before bedtime may also help (NORD). Swallowing trouble can lead to poor nutrition, dehydration and unplanned weight loss (TMA), so mention any of these to your care team.

Eating well on steroids

People with severe muscle inflammation may need more protein (NORD). On prednisone, frequent small meals, fewer high-calorie and sugary foods, less salt, calcium-rich foods and taking the medicine with food are recommended (TMA).

Preventing infections

Immune-suppressing treatment raises infection risk. Wash your hands often, clean cuts promptly, avoid people who are sick and raw or undercooked eggs and meat, and ask your doctor about vaccines — live vaccines should be avoided (TMA).

Support groups

People who have support from others cope better and feel more in control (TMA). The Myositis Association offers free virtual and regional support groups, groups for care partners, and one-on-one peer support (TMA). For families of children with JDM, the Cure JM Foundation runs online support groups, including one for mental and emotional support, plus conferences, virtual town halls and walks (Cure JM).

Children at school

Cure JM suggests telling teachers about the disease and its medicines, asking to be told when other children have contagious illnesses, and looking into a 504 plan or IEP, which may allow modified PE, a hat and sun-protective clothing outdoors, and excused absences for infusions (Cure JM). A diagnosis alone doesn’t guarantee a 504 plan, but an illness that is episodic or in remission can qualify if it would substantially limit a major life activity when active (Arthritis Foundation). Our guide to juvenile arthritis (JIA) covers school plans in more detail.

Still being researched: Acupuncture. We add each approach once its costs and results are sourced. Are you a practitioner with experience treating Dermatomyositis? Tell us.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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