Dermatomiositis anti-MDA5. Revisión de la literatura
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Keywords
Dermatomiositis, Anticuerpos, Úlcera
Resumen
La dermatomiositis positiva contra el gen 5 asociado a la diferenciación de melanoma (DM anti-MDA5) es una enfermedad rara que representa menos del 2%. La prevalencia de DM anti-MDA5 varía de 7 a 60%, con mayor prevalencia en asiáticos (11-60%) y mujeres. El cuadro clínico es muy variado y se acompaña por las características típicas de dermatomiositis, como la eritema en heliotropo, con edema, exantema eritematoso en la cara o la parte anterior del tórax (signo de V) y en la espalda y los hombros (signo del chal), las pápulas de Gottron en la parte dorsal de las articulaciones metacarpofalángicas o interfalángicas, que son patognomónicas por definición, pero uno de los signos más llamativos es la ulceración cutánea dolorosa que se encuentra hasta en un 82% de los casos, es profunda y en sacabocados muestran costras hiperqueratósicas. Para el diagnóstico son necesarias las erupciones típicas de la DM (pápulas de Gottron o signo de Gottron y erupción de heliotropo), junto con una patología cutánea de «dermatitis de interfase» o evidencia de miositis o un MSA (autoanticuerpos específicos de miositis). La inmunoprecipitación es el método de referencia para detectar MSA. Para su tratamiento se usan combinaciones de glucocorticoides e inmunosupresores; ademas, es necesaria la detección de enfermedad intersticial rápidamente progresiva (RP-ILD) con tomografía computarizada de alta resolución por su alta asociación con un pronóstico fatal.
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