Skin signs of Dermatomyositis: Heliotrope rash, Grotton papules and Shawl sign

Dermatomyositis is a connective tissue disorder characterized by chronic inflammation of voluntary muscles and skin. It is more common in women and the age of onset is 50-70 years.

Dermatomyositis skin
A. Shawl sign B. Grotton’s papules C. Heliotrope rash D. Telangiectasia

A) Heliotrope Rash:

  • It is a macular, confluent, purple or purple/red rash over both eyelids and periorbital tissue present with or without edema.
  • Mechanism: Unclear; probably indicates inflammation of underlying striated orbicularis oculi rather than the overlying skin
  • Resembles  Heliotropium peruvianum flower, which has small purple petals.

B) Gottron’s Papules:

  • Violaceous (violet-coloured) papules on the dorsal aspect of the interphalangeal joints.
  • Mechanism: Unclear
  • Pathognomic sign

C) Shawl sign:

  • Confluent, violaceous, macular (i.e. flat with violet/purple colouring) rash over the posterior shoulders and neck.
  • Mechanism: microvascular injury by complement deposition

D) Other skin signs:

  1. Photosensitivity
  2. Pruritus
  3. Nail fold telangiectasia
  4. Scaly scalp

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