Does your child have a skin rash and muscle weakness? Let's learn about Juvenile Dermatomyositis (JDM)

Is your child feeling a little tired? Does he seem to be having a hard time climbing stairs, running, or playing? Does he have red-purple patches of skin around his eyes and cheeks? Sometimes we think of these as a simple allergy, but this could be something more serious. Today we are talking about Juvenile Dermatomyositis, or JDM for short, a rare condition that affects children and presents with similar symptoms. Don't be afraid of the long name, let's explain everything in simple terms.

What is Juvenile Dermatomyositis (JDM)?

Simply put, JDM is a condition in which our body's own defense system, the immune system , suddenly goes haywire and starts attacking healthy parts of our own body. Specifically, it mainly affects our own skin, small blood vessels, and muscles . In medicine, diseases in which our own system works against us are called 'autoimmune diseases' . Imagine that the army that protects our country is attacking our own people.

This condition causes the child's muscles to weaken. This makes it difficult for them to stand up, climb stairs, run, play, and sometimes even do simple things like combing their hair. As a parent, it's understandable to feel sad and scared when you hear about any medical condition that prevents your child from performing daily tasks. But the best part is that treatments for JDM can very successfully control the symptoms and make your child's life much better.

Who is most likely to develop this condition?

JDM is a very rare disease. It usually begins in children between the ages of 5 and 10. It is also twice as common in girls as in boys. Although it can affect any child, research has found that it is more common in white children.

Adults can also experience these symptoms. But it usually occurs in the 40s or 50s. When this disease develops in adults, we call it Dermatomyositis . JDM and Dermatomyositis are both in the same group, that is, they are two diseases that belong to the group of inflammatory diseases of the muscles called Myositis .

What are the first characteristics of JDM?

Before the disease is diagnosed, you may notice some changes in your child. These may be the first signs of the disease. If you pay attention to these, you can see a doctor sooner.

Let's talk in depth about the two main symptoms of the disease.

Once JDM is confirmed, there are two main persistent symptoms: skin changes and muscle weakness.

1. Skin Rash

Children with JDM may have a very specific skin rash.

• Facial changes: This starts with the cheeks and eyelids turning red or purple . Sometimes the eyelids look swollen, so doctors may initially mistake it for a simple allergy.
• Fingernails, knees, and elbows: Over time, dry, red patches or bumps may develop on your child's fingernails, knees, and elbows. At first glance, these may look like eczema or psoriasis.
• Sun sensitivity: This is a very important symptom. When a child with JDM is exposed to sunlight, this skin rash becomes worse .

2. Muscle Weakness

This is the other main and most disturbing symptom of JDM. This weakness is mainly felt in the muscles near the middle of the body. That is:

• Shoulders
• Neck
• Hip area
• Abdominal muscles
• Upper arms and legs

When these muscles are weak, it can be very difficult for a child to perform everyday tasks. For example, getting up from a sitting position, climbing stairs, getting out of a chair, running, and combing their hair can be difficult.

What complications can occur if left untreated?

JDM is a medical condition that requires immediate medical attention. If left untreated, serious complications can occur.

• Calcium deposits: Hard, chalky lumps can form under the skin. These can restrict muscle movement and cause pain.
• Muscle contractures: Muscles become shortened and begin to contract when the joints are bent. This can make it difficult to extend the limb.
• Ulcers: Sores can occur on the skin or in the gastrointestinal tract.
• Severe weakness: Severe weakness of the breathing and swallowing muscles can be life-threatening.

Why is this happening? What is the cause of JDM?

As we discussed earlier, JDM is an autoimmune disease. But why does our own immune system suddenly turn against us? Doctors haven't really found a specific cause for this yet .

But there are several theories about this. One main theory is that when something, such as a viral infection, enters the body, our immune system starts to fight it. However, even after the infection is gone, this immune system does not stop fighting. Instead, it is believed that it continues to function and begins to attack our own body's cells. Researchers also believe that there may be a genetic component to this.

How does the doctor diagnose this disease? (Diagnosis)

When you take your child to a doctor, he or she will first examine the child carefully. In particular, they will check for a skin rash and muscle strength. Then they will ask you about your symptoms.

Several tests are performed to confirm the exact diagnosis.

• Blood tests: There is no single blood test that can immediately diagnose JDM. However, blood tests can check for things like inflammation levels in the body, levels of muscle enzymes that accumulate in the blood when muscles are damaged, and specific proteins (autoantibodies) that are commonly seen in JDM.
• Electromyography (EMG): In this test, tiny needle-like electrodes are inserted into the muscles and the electrical activity of those muscles is measured. This can help detect any abnormalities in muscle function.
• MRI (Magnetic Resonance Imaging): An MRI scan can produce detailed images of the inside of the body. It can clearly see things like very subtle swelling and inflammation in the muscles.
• Muscle biopsy: In this, a small surgical procedure is performed to remove a very small piece of tissue from the affected muscle and examine it under a microscope. This can help determine if there is inflammation in the muscles and whether it is caused by JDM or another disease, such as Muscular Dystrophy .
• Nailfold capillaroscopy: This is a very simple, painless test. A special light and magnifying lens are used to examine the tiny blood vessels under the child's nails. These blood vessels are often swollen in children with JDM.

What are the treatments for JDM?

The main goal of JDM treatment is to reduce inflammation in the body and improve the child's quality of life. Although many children have to live with JDM for several years, treatment can control the symptoms very well. After treatment, many children go months or years without any symptoms. We call this 'remission' .

Treatment methods can be divided into two main parts.

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