DEAR DR. GOTT: I am writing in reference to the lady with white hair that is turning yellow. I, too, had the same problem only to be diagnosed shortly after with the autoimmune disease dermatomyositis. This was the cause of my yellowing hair. I am not saying that she has this, but it is another potential cause. I would also appreciate your opinion on this disease. I enjoy your column very much.
DEAR READER: Dermatomyositis is an uncommon inflammatory disease that causes a distinctive skin rash and muscle weakness. It can occur at any age, but is most common in adults in their late 40s to early 60s, as well as in children between the ages of 5 and 15. Women are affected more often than are men. It may appear suddenly, develop gradually, or take several weeks or months. Periods of remission where symptoms improve or disappear may occur. The skin rash is violet or a dusky red and most commonly occurs on the chest, back, face and eyelids and around the nails, knuckles, elbows and knees. It is often patchy and may have bluish-purple discolorations. The rash is typically the first — and in some cases only — symptom.
Muscle weakness occurs symmetrically (on both sides of the body). It generally affects the neck, shoulders, upper arms, hips and thighs. It is progressive, meaning it worsens over time. Pain may be experienced by up to half of all sufferers and is generally mild.
Other symptoms and complications may include difficulty swallowing, muscle and joint pain, fatigue, fever, weight loss, shortness of breath, gastrointestinal ulcers and perforations (most common in children), breathing difficulties, heart inflammation, pneumonia, aspiration, hardened deposits of calcium under the skin (most common in children) and more. Pregnancy may worsen symptoms during active periods and increases the risk of premature or stillbirths. When in remission, these risks are substantially lower.
Dermatomyositis may occur with other conditions such as lung or cardiovascular diseases, Raynaud’s and connective tissue disorders, including lupus, Sjogren’s, scleroderma or rheumatoid arthritis.
The first line of treatment is oral corticosteroids. Often high doses are given and tapered down to a lower maintenance dose. Improvement is commonly experienced within two to four weeks, but therapy may be necessary for years. Occasionally, topical steroids may be used.
Other medications may be used in conjunction with steroids or alone. This is typically done if symptoms fail to improve or side effects become severe. Corticosteroid-sparing agents such as azathioprine or methotrexate are then considered. Anti-malarial drugs, immunosuppressants, the anti-rejection drug tacrolimus and over-the-counter or prescription pain relievers may be beneficial.
Antibody therapy known as IVIg (intravenous immunoglobulin) may be considered. High doses can block the autoantibodies (responsible for the inflammation) from attacking. Rituximab depletes a certain type of lymphocyte and showed improvement in a small study.
Physical and speech therapy can help by encouraging regaining muscle strength, assisting with swallowing, movement and more. Surgery to remove painful calcium deposits may also be recommended.
At home, under the approval and direction of a physician or physical therapist, exercise can help maintain and regain muscle strength. It is important not to overdo or push yourself because this can set progress back. Resting whenever tired is vital. Also, applying sunscreen whenever going outside is beneficial because areas affected by the rash are more sensitive to the effects of the sun.
As for your connection to the yellowing hair, I did not see mention of this anywhere and am not sure how this condition could cause it; however, it led to your diagnosis, hopefully early, so you can do everything possible to prevent severe muscle-strength loss. If you aren’t already, you may consider seeing a rheumatologist who specialists in autoimmune disorders.