What would be your next step in management of a dermatomyositis patient on hydroxychloroquine and methotrexate whose skin is still active?  

There are many different options for this kind of scenario. Depending on the physician's preference, patient's lifestyle, and insurance coverage, one could switch to mycophenolate, which seems to be more effective for skin manifestations, or azathioprine. If the patient did have a partial response ...