Dermatomyositis

Question 1

Describe this skin lesion over the face

Answer 1

Heliotrope rash around the eyes
- Purple/violet colour symmetrical distribution over periorbital skin with subcutaneous oedema
(derived from heliotropium - purple flower)

Question 2

Describe this skin lesion over the hands
What are the causes that may resemble such changes?

Answer 2

Gottron papules - flat topped, violaceous, scaly papules or plaques over knuckles, elbows and knees
- Can have thick psoriasiform scale
- Most prominent over bony prominences, esp MCP, PIP and DIP, elbows, knees, feet

Other causes resembling such lesions:
1. SLE
2. Psoriasis
3. Lichen planus
4. Drug-induced changes - hydroxyurea, penicillamine, statin, quinidine, phenylbutazone

Question 3

Describe this skin lesion

Answer 3

Shawl sign - hyperpigmentation and telangiectasia (termed poikiloderma) over sun-exposed skin
- Photosensitive distribution
- Mainly V shaped over neck and upper chest
- Other sites: extensors of arm, back

Question 4

Clinical findings of dermatomyositis
- Pathognomic cutaneous feature + muscle weakness

Answer 4

A. Cutaneous manifestations
1.

B. Proximal muscle weakness

C.