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By Lawrence A. Schiffman, DO, and Stephen M. Schleicher, MD
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CASE:
A 43-year-old woman presents with red lesions
on her hands. Her family history is significant
for systemic lupus erythematosus affecting her
mother. Physical examination reveals erythematous-
to-violaceous papules on the dorsal surface
of all fingers, including both the proximal
and the distal interphalangeal joints. The
papules are asymptomatic. Examination with a
magnifying glass reveals telangiectasia involving
the proximal nail folds. A facial rash is also
noted. The patient denies any systemic complaints,
including muscle weakness.
WHAT IS YOUR DIAGNOSIS?
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This patient was diagnosed with Gottron’s papules,
which are associated with dermatomyositis. Classified
as a connective tissue disease, dermatomyositis presents
with various cutaneous manifestations, including
proximal nail fold telangiectasia, Gottron’s
papules, and heliotrope rash (a purplish erythema and
edema of the malar and periorbital regions of the
face). Proximal muscle weakness may precede or follow
the onset of skin findings. Systemic involvement
correlates with elevated muscle-associated enzymes.
Treatment usually entails use of high-dose oral
steroids and may also require antimalarials and immunosuppressive
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Dr. Schiffman is a dermatology resident at St. John’s Episcopal Hospital in Far Rockaway, New York. Dr. Schleicher is director of DermDx Centers and a
clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 38(7):31-2, 2006
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