Reactive arthritis (Reiter's syndrome with conjunctivitis, urethritis, and diarrhea) ( Fig. 22 ) usually follows a bout of gastroenteritis or urethritis. Implicated organisms include Campylobacter, Shigella, Salmonella, Ureaplasma, and Yersinia species. Affected patients, usually men, often have vesicles and crusted plaques on the penis (circinate balanitis) and erythematous pustules and papules on the palms and soles (keratoderma blennorrhagicum) that can mimic pustular psoriasis. More than 50% of patients have sacroiliitis, correlating with the presence of HLA-B27 antigen, but few patients have the classic triad of urethritis, conjunctivitis, and arthritis.
There are no specific recommendations about when to initiate corticosteroid treatment. Data suggest that oral steroids should be used in patients with stages II and III disease, with moderate to severe or progressive symptoms and chest radiograph changes. It is unclear if asymptomatic patients will ever need therapy, even if they have diffuse lung infiltration. Because there is no consensus on the optimal dosage or duration of therapy, the course is individualized for each patient. A recent joint statement of the American Thoracic Society, the European Respiratory Society, and the World Association of Sarcoidosis and Other Granulomatous Disorders 1 included the following guidelines: an initiation dose of prednisone of 20 to 40 mg per day or its equivalent is recommended. Every-otherday dosing may be considered. Patients should be evaluated after one to three months for response. Patients who fail treatment after three months usually will not respond to a more protracted course of treatment. In responders, the prednisone dosage should be tapered to 5 to 10 mg per day or to an every-otherday regimen, and therapy should continue for a minimum of 12 months. 1 There is no consensus guidance on treatment beyond two years. 2 Patients must be monitored after cessation of treatment for possible relapse; some patients will require long-term low-dose therapy to prevent recurrent disease. 1
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Every year between and people per million receive a diagnosis of PM or DM.  Around children per million per year are diagnosed with DM (termed juvenile dermatomyositis ), with an average age of onset of seven years. Diagnosis of adult DM commonly occurs between 30 and 50 years of age. PM is an adult disease, usually emerging after the age of twenty. PM and DM are more common in females, more common in Caucasians, and least common in Asians. At any given time, about people per million have IBM; it emerges after the age of 30 (usually after 50), and may be more common in males. 
Occlusive therapy is highly effective. Apply the topical steroids mentioned above under subacute eczema and cover with a plastic wrap such as Saran wrap. The plastic dressing does not have to be airtight. Secure the dressing with tape on either end. A sock will hold the plastic dressing against a foot. The dressing may stay on for 2 hours or overnight. Remove the dressing and apply an emollient or more medication. It is not necessary to wash the skin each time a plastic dressing is applied. The appearance of pustules indicates a secondary infection. Stop treatment and prescribe topical or oral antibiotics for this side effect of occlusive therapy.
Every year between and people per million receive a diagnosis of PM or DM.  Around children per million per year are diagnosed with DM (termed juvenile dermatomyositis ), with an average age of onset of seven years. Diagnosis of adult DM commonly occurs between 30 and 50 years of age. PM is an adult disease, usually emerging after the age of twenty. PM and DM are more common in females, more common in Caucasians, and least common in Asians. At any given time, about people per million have IBM; it emerges after the age of 30 (usually after 50), and may be more common in males.