However, higher doses have been used successfully in selected cases. Intravenous cyclophosphamide therapy has also been used successful in many centers for children with severe dermatomyositis. As with methotrexate, cyclophosphamide administration requires careful monitoring of hematological parameters. Cyclophosphamide has the advantage of not being associated with hepatic cirrhosis, but methotrexate is less strongly associated with a subsequent risk of sterility or neoplastic disease. In addition, methotrexate can be administered on an outpatient basis without concern about possible bladder toxicity.
Limited experience is available with the use of intravenous gammaglobulin therapy.
In small studies it has been associated with a significant steroid sparing effect. The excessive costs of this therapy make these limited benefits of questionable utility unless the patient has failed to respond to less costly therapies. There is also an increasing experience with cyclosporine A. Despite initially promising results many centers report a general lack of long term efficacy. No controlled studies have been reported. Diffuse calcification of subcutaneous tissues or muscle groups is a potential complication of dermatomyositis which may be severely debilitating.