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Cutaneous features of dermatomyositis Characteristic skin changes of dermatomyositis include: Heliotrope rash — bilateral lilac discolouration of the eyelids (particularly the upper eyelids) with swelling of the eyelids and skin around the eyes Heliotrope rash Heliotrope rash Heliotrope rash Shawl sign — fixed redness affecting the back, shoulders, chest, and neck which can become poikilodermatous Shawl sign over the shoulder Shawl sign over the upper back Photosensitivity — sunburn reaction over the ‘V’ area of the anterior chest, face, and other sun-exposed sites Photosensitive rash on the upper arm Photosensitive rash on the V of chest Gottron papules — purple papules and plaques over the tops of the small joints of the hands Gottron papules over the joints of the hands Gottron papules over finger joints Violaceous hue of Gottron papules Gottron sign — redness over the backs of the hands, elbows, and knees Gottron sign over the knees Gottron sign over the elbow Gottron sign over a knee Scalp involvement — itchy scaly scalp with inflammation and diffuse, non-scarring thinning of the hair, and sometimes poikiloderma Scaly scalp in dermatomyositis Scaly scalp with hair thinning in dermatomyositis Nailfold changes — ragged cuticles and red nailfolds
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