Dermatomyositis

Clinical features

History

  1. Rash made worse by sunlight
  2. Dysphagia
  3. Dysphonia

Examination

  1. Heliotrope rash (heliotrope: red to purple flower that turns toward the sun)
  2. Gottron's papules (raised violaceous scaly eruption on knuckles of hand)
  3. Thickened, irregular eponychia.
  4. Proximal muscle weakness
  5. Weakness of neck flexors

Ix

  1. CK-MM
  2. EMG (spontaneous fibrillation)
  3. muscle biopsy (muscle necrosis and phagocytosis)

Treatment

Immunosuppression: Steroids first. Consider methotrexate, azathioprine if unresponsive or intolerant to steroids.