Dermatomyositis

Diagnosis: Dermatomyositis

Dermatomyositis

Clinical Presentation

Dermatomyositis

Clinical History

Submitted by Ellie Goulding MD. Originally posted January 23, 2017.

Treatment

See case discussion.

Differential Diagnosis

• Systemic lupus erythematosus • Polymyositis • Contact dermatitis • Seborrheic dermatitis • Psoriasis • Drug eruption • Photosensitive eruption • Trichinosis

Key Learnings

• Classic cutaneous findings: heliotrope rash (violaceous periorbital erythema), Gottron papules (over MCPs/IPs/knees/elbows), V-sign, shawl sign • Gottron papules are pathognomonic for dermatomyositis • Adult dermatomyositis has significant malignancy association (~15-30%) — cancer screening essential • Myositis-specific antibodies: anti-Mi-2, anti-MDA5 (amyopathic DM with ILD risk), anti-TIF1-gamma (cancer association) • Amyopathic DM: skin disease without muscle involvement for ≥6 months • Anti-MDA5 DM associated with rapidly progressive interstitial lung disease • Nailfold capillaroscopy shows dilated, tortuous capillary loops with dropout

Tags: dermatomyositis, ellie goulding md