10.5826/dpc.1302a126
text/xml
2160-9381
2831
en
Daniel Morgado-Carrasco
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Inverse Gottron Papules in Dermatomyositis 
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Image Letter
2023-04-29
2022-09-08
2023-04-29
2023-06-05
e2023126
Dermatol Pract Concept
Daniel Morgado-Carrasco
2023/04/29
10.5826/dpc.1302a126
e2023126
Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
2160-9381
en
e2023126
Anjani G, Govindarajan S, Sudhakar M, Chaudhary H, Rawat A, Kumar Jindal A. Catch the thief by its marks: inverse Gottron papules, interstitial lung disease, anti MDA-5 antibody positivity in juvenile dermatomyositis. Rheumatology. 2021;60(2):e56–8.
Inverse Gottron Papules in Dermatomyositis 
https://dpcj.org/index.php/dpc/article/download/2831/2102
          Inverse Gottron Papules in Dermatomyositis
                           Maria-Elena Gimeno-Ribes1, Daniel Morgado-Carrasco1


1 Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain



Citation: Gimeno-Ribes ME, Morgado-Carrasco D. Inverse Gottron Papules in Dermatomyositis.
Dermatol Pract Concept. 2023;13(2):e2023126. DOI: https://doi.org/10.5826/dpc.1302a126
Accepted: September 26, 2022; Published: April 2023
Copyright: ©2023 Gimeno-Ribes et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Daniel Morgado-Carrasco, Dermatology Department, Hospital Clínic de Barcelona, Spain. Tel. (+34) 935 464 710
Fax (+34) 935 464 729 E-mail: morgadodaniel8@gmail.com




Case Presentation                                                        to the Rheumatology department, where a muscle biopsy
                                                                         was performed, confirming the diagnosis of Dermatomyo-
An otherwise healthy 40-year-old woman, working as a                     sitis. An autoimmunity panel showed positivity for antiMi2
secretary, presented to our clinic complaining of photo-                 antibodies. All other autoantibodies were negative. No ma-
sensitivity and muscle weakness. Physical examination                    lignancies were found on imaging tests. A high-resolution
revealed facial erythematous desquamative plaques, and                   computed tomography of the lungs showed no pathologic
non-tender pale hyperkeratotic papules over the palmar as-               findings. Prednisone 30 mg/day, methotrexate 15 mg/week
pect of the interphalangeal joints (Figure 1). She was sent              and hydroxychloroquine 400 mg/day were started, with
                                                                         resolution of muscular symptomatology after 2 months.
                                                                         Facial cutaneous manifestations and photosensitivity
                                                                         showed only partial response. Palmar papules persisted
                                                                         during the follow-up (12 months), and antiMi2 antibodies
                                                                         remained positive.



                                                                         Teaching Point
                                                                         Dermatomyositis can be associated with a wide range of
                                                                         cutaneous manifestations. Inverse Gottron papules are ker-
                                                                         atotic papules located on the flexor aspects of the fingers
                                                                         (distal and proximal interphalangeal joints, and metacarpo-
                                                                         phalangeal joints), and are an infrequently reported clinical
                                                                         sign of dermatomyositis [1,2]. In some case series, an asso-
Figure 1. Inverse Gottron papules. Pale hyperkeratotic papules over      ciation between inverse Gottron papules and antiMDA5 an-
the palmar aspect of interphalangeal joints.                             tibodies or Juvenile dermatomyositis has been reported, and



Image Letter | Dermatol Pract Concept. 2023;13(2):e2023126                                                                          1
patients with this clinical sign might have an increased risk    References
of developing interstitial lung disease, and a worse progno-
sis [1,2]. However, there is scarce literature regarding this    1. Irie K, Matsumura N, Hoshi M, Yamamoto T. Inverse Gottron’s
                                                                    papules in patients with dermatomyositis: an underrecognized
manifestation, and clinical implications remain unclear and
                                                                    but important sign for interstitial lung disease. Int J Dermatol.
should be further assessed. Regarding physiopathology, in-
                                                                    2021;60(2):e62-e65. DOI: 10.1111/ijd.15204. PMID: 32970839.
verse Gottron papules may be induced by keratinocyte dam-        2. Anjani G, Govindarajan S, Sudhakar M, Chaudhary H, Rawat
age secondary to mechanical injury [1].                             A, Kumar Jindal A. Catch the thief by its marks: inverse Gottron
    Inverse Gottron papules are an infrequent manifestation         papules, interstitial lung disease, anti MDA-5 antibody positivity
of dermatomyositis. Recognizing this clinical sign can help in      in juvenile dermatomyositis. Rheumatology. 2021;60(2):e56–
                                                                    e58. DOI: 10.1093/rheumatology/keaa433. PMID: 32888028.
the diagnosis of this disorder.




2                                                                      Image Letter | Dermatol Pract Concept. 2023;13(2):e2023126
