What is your approach to treating dermatomyositis patients with pruritus recalcitrant to oral and topical steroids?  

I find this issue of pruritus is best handled by getting better control of the cutaneous inflammatory disease. In this regard, typical DMARD agents (e.g. MTX, mycophenolate, etc) can be helpful in addition to IVIG or even JAK inhibitors. Obviously, all a risk/benefit assessment depends on how debili...

I would also add that I have had some success adding compounded or off-label topical jak inhibitors (ruxolitinib or tofacitinib) as well as oral jak inhibitors (tofacitinib or Upadacitinib but sure that others could work as well). I have also had success adding dupilumab off-label as well. This is a...