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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What is the treatment for Polymyositis and Fat necrosis in a 78 year old?

78 y/o AA with Polymyositis and RA maintained on immuran and prdnisone c painful subcutaneous nodules; 2 of which have ulcerated. Bx shows subcutaneous fat necrosis with calcification. neg for AFB and fungal elements. She has had these nodules come and go for some years. The skin above is more pigmented than her surrounding skin. No fevers, chills, sweats. no other major constitutional s/s. no responding (in fact enlarging) to standard moist occlusive dressing and excisional debridement. She also has CKD stage 3, never has been on dialysis. Also have DM, A1c obese
Tue, 11 Nov 2014
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Geriatrics Specialist 's  Response
Hi,
Thanks for asking.
Based on your query, my opinion is as follows.
1. Ulcerated nodules can be excised and removed. Others need not be touched.
2. Healing will take longer due to age and associated diabetes mellitus. Additionally corticosteroid therapy will also delay. If necessary healing can be hastened with skin covers.
3. Control of blood sugar essential. Regular sterile dressing with oral antibiotic therapy essential to avoid infections.
Hope it helps.
Any further queries, happy to help again.
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