Dermatomyositis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Some of the more common physical examination findings for dermatomyositis include Gottron's sign, a heliotrope rash on the upper eyelids, the shawl sign, erythroderma, periungual telangiectasia, cracked skin on the hands, psoriaform changes, and calcinosis cutis.

Physical Examination

Skin findings occur in dermatomyositis but not polymyositis and are generally present at diagnosis. Gottron's sign is an erythematous, scaly eruption occurring in symmetric fashion over the MCP and interphalangeal joints (can mimic psoriasis). Heliotrope rash (or lilac rash) is a violaceous eruption on the upper eyelids, often with swelling (most specific, though uncommon). Shawl (or V-) sign is a diffuse, flat, erythematous lesion over the chest and shoulders or in a "V" over the anterior neck and chest, worsened with UV light. Erythroderma is a flat, erythematous lesion similar to the shawl sign but located in other areas, such as the malar region and the forehead. Periungual telangiectasias and erythema occur.

Mechanic's hands (also in PM) refers to rough, cracked skin at the tips and lateral aspects of the fingers forming irregular dirty-appearing lines that resemble those seen in a laborer (this is also associated with the anti-synthetase syndrome) (See: sclerodactyly). Psoriaform changes in the scalp can occur. Centripetal flagellate erythema comprises linear, violaceous streaks on the trunk (possibly caused by itching pruritic skin). Calcinosis cutis(deposition of calcium in the skin) is usually seen in juvenile DM, not adult DM. Dysphagia (difficulty swallowing) is another feature, occurring in as much as 33% of cases.

Heliotrope rash (Dermatomyositis) Proximal muscle weakness

Skin

Face

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  Dermatomyositis Adapted from Dermatology Atlas.
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  Dermatomyositis Adapted from Dermatology Atlas.
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  Dermatomyositis Adapted from Dermatology Atlas.
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  Dermatomyositis Adapted from Dermatology Atlas.

Hand

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  Dermatomyositis Adapted from Dermatology Atlas.
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  Dermatomyositis Adapted from Dermatology Atlas.
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  Dermatomyositis Adapted from Dermatology Atlas.
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  Dermatomyositis Adapted from Dermatology Atlas.
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  Dermatomyositis Adapted from Dermatology Atlas.