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Dermatomyositis: An autoimmune neuromuscular condition with multiple dermatologic features. As shown here, patient may exhibit an erythematous eruption, prominent in sun exposed areas (note V-shaped distribution around upper chest). Other findings (not shown here) include: purplish rash with edema around eyes (heliotropic rash), telangiectasias at the nail beds, scaly purple/red papules on knuckles (Groton’s papules), hyperkeratosis and fissuring on the palms and lateral hand surfaces (“mechanic's hands”), subcutaneous nodules. These can occur prior to onset neurological symptoms.

Neurological manifestations are from an inflammatory myopathy, resulting in painless, progressive (over weeks), proximal weakness – which can lead to difficulty getting up from sitting, climbing stairs, raising arms, other. Earliest muscles affected are typically neck flexors, pectoral muscles, shoulder girdle. Findings can be asymmetric. Dysarthria and dysphagia occurs in 1/3 of cases. No sensory deficits and reflexes preserved until late. Can affect children and adults, women > men. Can affect lungs (fibrosis) and heart (conduction system abnormalities). In adults, associated with multiple types of cancer including: breast, prostate, colon, lymphoma and others.

Image Credit

Charlie Goldberg, M.D.