Polymyositis/Dermatomyositis

Heliotropic rash of dermatomyositis. B. Gottron's papules of dermatomyositis.

Dale Berg , Katherine Worzala, Atlas of Adult Physical Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2006.

This patient with dermatomyositis has the characteristic facial (A) and extremity findings (B).

From Fleisher  GR, MD, Ludwig  S, MD, Baskin  MN, MD. Atlas of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins, 2004.

This patient with dermatomyositis has the characteristic facial (A) and extremity findings (B).

From Fleisher  GR, MD, Ludwig  S, MD, Baskin  MN, MD. Atlas of Pediatric Emergency Medicine. Philadelphia: Lippincott Williams & Wilkins, 2004.

Classic Gottron's papules on the dorsum on the fingers of this patient with dermatomyositis.

Dale Berg, Katherine Worzala, Atlas of Adult Physical Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2006.

Skin changes seen in dermatomyositis. A: Gottron's papules are scaly papules overlying the extensor surfaces of the hands (over the metacarpophalangeal and proximal interphalangeal joints in this case), elbows, knees, or malleoli. This patient also has sclerodactyly and arthritis of the metacarpophalangeal and proximal interphalangeal joints. B: The heliotrope rash is a purplish discoloration around the eyes, especially on the upper lids. C: Linear extensor erythema overlies the extensor surface of the hands beyond the usual location of Gottron's papules or sign. D: Periungual vasculitic changes and cuticular overgrowth. E: Photosensitive diffuse erythroderma with accentuated erythema in the V of the neck (V sign) in a patient with cancer-associated dermatomyositis. F: Drying and cracking of the skin over the lateral and palmar surfaces of the fingers, known as “mechanic's hands,” is seen frequently in patients with autoantibodies to aminoacyl-tRNA synthetases (the antisynthetase syndrome).

William J. Koopman, Larry W. Moreland, Arthritis and Allied Conditions A Textbook of Rheumatology, 15e. Philadelphia: Lippincott Williams & Wilkins, 2005.

FIG. 75.1. Skin changes seen in dermatomyositis. A: Gottron's papules are scaly papules overlying the extensor surfaces of the hands (over the metacarpophalangeal and proximal interphalangeal joints in this case), elbows, knees, or malleoli. This patient also has sclerodactyly and arthritis of the metacarpophalangeal and proximal interphalangeal joints. B: The heliotrope rash is a purplish discoloration around the eyes, especially on the upper lids. C: Linear extensor erythema overlies the extensor surface of the hands beyond the usual location of Gottron's papules or sign. D: Periungual vasculitic changes and cuticular overgrowth. E: Photosensitive diffuse erythroderma with accentuated erythema in the V of the neck (V sign) in a patient with cancer-associated dermatomyositis. F: Drying and cracking of the skin over the lateral and palmar surfaces of the fingers, known as “mechanic's hands,” is seen frequently in patients with autoantibodies to aminoacyl-tRNA synthetases (the antisynthetase syndrome).

William J. Koopman, Larry W. Moreland, Arthritis and Allied Conditions A Textbook of Rheumatology, 15e. Philadelphia: Lippincott Williams & Wilkins, 2005.

Skin changes seen in dermatomyositis. A: Gottron's papules are scaly papules overlying the extensor surfaces of the hands (over the metacarpophalangeal and proximal interphalangeal joints in this case), elbows, knees, or malleoli. This patient also has sclerodactyly and arthritis of the metacarpophalangeal and proximal interphalangeal joints. B: The heliotrope rash is a purplish discoloration around the eyes, especially on the upper lids. C: Linear extensor erythema overlies the extensor surface of the hands beyond the usual location of Gottron's papules or sign. D: Periungual vasculitic changes and cuticular overgrowth. E: Photosensitive diffuse erythroderma with accentuated erythema in the V of the neck (V sign) in a patient with cancer-associated dermatomyositis. F: Drying and cracking of the skin over the lateral and palmar surfaces of the fingers, known as “mechanic's hands,” is seen frequently in patients with autoantibodies to aminoacyl-tRNA synthetases (the antisynthetase syndrome).

William J. Koopman, Larry W. Moreland, Arthritis and Allied Conditions A Textbook of Rheumatology, 15e. Philadelphia: Lippincott Williams & Wilkins, 2005.

Skin changes seen in dermatomyositis. A: Gottron's papules are scaly papules overlying the extensor surfaces of the hands (over the metacarpophalangeal and proximal interphalangeal joints in this case), elbows, knees, or malleoli. This patient also has sclerodactyly and arthritis of the metacarpophalangeal and proximal interphalangeal joints. B: The heliotrope rash is a purplish discoloration around the eyes, especially on the upper lids. C: Linear extensor erythema overlies the extensor surface of the hands beyond the usual location of Gottron's papules or sign. D: Periungual vasculitic changes and cuticular overgrowth. E: Photosensitive diffuse erythroderma with accentuated erythema in the V of the neck (V sign) in a patient with cancer-associated dermatomyositis. F: Drying and cracking of the skin over the lateral and palmar surfaces of the fingers, known as “mechanic's hands,” is seen frequently in patients with autoantibodies to aminoacyl-tRNA synthetases (the antisynthetase syndrome).

William J. Koopman, Larry W. Moreland, Arthritis and Allied Conditions A Textbook of Rheumatology, 15e. Philadelphia: Lippincott Williams & Wilkins, 2005

Skin changes seen in dermatomyositis. A: Gottron's papules are scaly papules overlying the extensor surfaces of the hands (over the metacarpophalangeal and proximal interphalangeal joints in this case), elbows, knees, or malleoli. This patient also has sclerodactyly and arthritis of the metacarpophalangeal and proximal interphalangeal joints. B: The heliotrope rash is a purplish discoloration around the eyes, especially on the upper lids. C: Linear extensor erythema overlies the extensor surface of the hands beyond the usual location of Gottron's papules or sign. D: Periungual vasculitic changes and cuticular overgrowth. E: Photosensitive diffuse erythroderma with accentuated erythema in the V of the neck (V sign) in a patient with cancer-associated dermatomyositis. F: Drying and cracking of the skin over the lateral and palmar surfaces of the fingers, known as “mechanic's hands,” is seen frequently in patients with autoantibodies to aminoacyl-tRNA synthetases (the antisynthetase syndrome).

William J. Koopman, Larry W. Moreland, Arthritis and Allied Conditions A Textbook of Rheumatology, 15e. Philadelphia: Lippincott Williams & Wilkins, 2005.

<bold>FIG. 75.3.</bold> Histopathology of inflammatory myopathies. A,B: Muscle biopsies from polymyositis patients tend to show focal endomysial infiltration by mononuclear cells (A: hematoxylin and eosin stain), while those from dermatomyositis patients show more perivascular and interstitial inflammation with perifascicular myofiber atrophy (B: modified trichrome stain). C: Transverse fresh-frozen section of muscle from a patient with inclusion body myositis displaying purplish granular materia...

Skin changes seen in dermatomyositis. A: Gottron's papules are scaly papules overlying the extensor surfaces of the hands (over the metacarpophalangeal and proximal interphalangeal joints in this case), elbows, knees, or malleoli. This patient also has sclerodactyly and arthritis of the metacarpophalangeal and proximal interphalangeal joints. B: The heliotrope rash is a purplish discoloration around the eyes, especially on the upper lids. C: Linear extensor erythema overlies the extensor surface of the hands beyond the usual location of Gottron's papules or sign. D: Periungual vasculitic changes and cuticular overgrowth. E: Photosensitive diffuse erythroderma with accentuated erythema in the V of the neck (V sign) in a patient with cancer-associated dermatomyositis. F: Drying and cracking of the skin over the lateral and palmar surfaces of the fingers, known as “mechanic's hands,” is seen frequently in patients with autoantibodies to aminoacyl-tRNA synthetases (the antisynthetase syndrome).

William J. Koopman, Larry W. Moreland, Arthritis and Allied Conditions A Textbook of Rheumatology, 15e. Philadelphia: Lippincott Williams & Wilkins, 2005.

<bold>FIG. 75.1.</bold> Skin changes seen in dermatomyositis. A: Gottron's papules are scaly papules overlying the extensor surfaces of the hands (over the metacarpophalangeal and proximal interphalangeal joints in this case), elbows, knees, or malleoli. This patient also has sclerodactyly and arthritis of the metacarpophalangeal and proximal interphalangeal joints. B: The heliotrope rash is a purplish discoloration around the eyes, especially on the upper lids. C: Linear extensor erythema overli...

FIG. 2.18. This patient with dermatomyositis has the characteristic facial (A) and extremity findings (B).

FIG. 2.18. This patient with dermatomyositis has the characteristic facial (A) and extremity findings (B).

<bold><italic>Figure 7.31.</bold></bold> Classic heliotropic rash about the eyes of this patient with dermatomyositis.

Dermatomyositis: face

Dermatomyositis: nail-fold dilated capillary loops