10.5826/dpc.1201a13
text/xml
2160-9381
1661
en
Biju Vasudevan
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
hyperpigmentation
Dermoscopy of Dermatomyositis in Dark Skin
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-02-02
2021-01-28
2022-02-02
2022-02-09
e2022013
Dermatol Pract Concept
Biju Vasudevan
2022/02/02
10.5826/dpc.1201a13
e2022013
Armed Forces Medical College, Pune, India
2160-9381
hyperpigmentation
en
e2022013
Namiki T, Hashimoto T, Hanafusa T, Miura K, Yokozeki H. Case of dermatomyositis with Gottron papules and mechanic's hand: dermoscopic features. J Dermatol. 2018;45(1):e19-e20. DOI: 10.1111/1346-8138.14072. PMID: 28971518.
Dermoscopy of Dermatomyositis in Dark Skin
https://dpcj.org/index.php/dpc/article/download/1661/1476
        Dermoscopy of Dermatomyositis in Dark Skin
            Shekhar Neema1, Rohit Kothari1, Ahmed Waheed Kashif1, Deepak Vashisht1,
                                       Biju Vasudevan1


1 Armed Forces Medical College, Pune, India



Key words: dermatomyositis, dermoscopy, dermatoscopy
Citation: Neema S, Kothari R, Kashif AW, Vashisht D, Vasudevan B. Dermoscopy of dermatomyositis in dark skin. Dermatol Pract
Concept. 2022;12(1):e2022013. DOI: https://doi.org/10.5826/dpc.1201a13
Accepted: May 8, 2021; Published: January 2022
Copyright: ©2022 Neema 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: Shekhar Neema MD, FEBDV, Associate Professor, Armed Forces Medical College, Pune, India.
E-mail: shekharadvait@gmail.com




Introduction                                                                  Dermoscopy of the peri-ocular area revealed a brown re-
                                                                         ticular pigment network, gray dots and globules and linear
Dermatomyositis is an idiopathic inflammatory myopathy                   out-of-focus vessels (Figure 1E). Dermoscopy of the Gottron
characterized by muscle weakness and cutaneous features                  papule shows white-to-pink structureless areas and a retic-
such as heliotrope rash, Gottron papule, confluent macular               ular pigment network (Figure 1F). Histopathology revealed
erythema, poikiloderma, mechanic’s hand, ragged cuticle and              atrophic epidermis, basal cell vacuolation, melanophages in
periungal telangiectasia [1]. The characteristic cutaneous               the papillary dermis, and presence of focal mucin (Figure 1G).
manifestations are difficult to appreciate in individuals with           Creatinine phosphokinase was 573 IU/ml, antinuclear anti-
darker skin types thus making the diagnosis challenging.                 body was 3+ (speckled pattern). Magnetic resonance imaging
                                                                         of the thigh showed myositis, and high-resolution computed
                                                                         tomography of chest were suggestive of interstitial lung dis-
Case Presentation
                                                                         ease. A diagnosis of dermatomyositis was made based on
A 59-year-old woman presented with complaints of pru-                    clinical, histopathological, serological, and imaging findings.
ritic dark lesions over her entire body and progressive                  The patient was treated with methylprednisolone pulse of
muscle weakness of 2 months’ duration. Examination                       1 g per day for 3 days, hydroxychloroquine 200 mg once a
revealed hyperpigmentation involving the face, periocu-                  day and a tapering dose of oral steroids.
lar region (heliotrope rash), upper back (Shawl sign), and                    In a second case, a 45-year-old woman presented with
v area of neck (V sign), hyperpigmented papules over the                 similar complaints of photosensitivity, pruritic dark lesions
knuckles (­Gottron papule), hyperpigmented macules on the                over photo-exposed areas of the face, trunk, and extremi-
hand (Gottron sign), hyperpigmented papules over the lat-                ties, swelling around the eyes, and proximal muscle weak-
eral aspect of the index finger and medial aspect of thumb               ness. Dermatological examination showed hyperpigmented
(­mechanic’s hand), and ragged cuticles (Figure 1, A-D).                 macules over the forehead and lateral sides of cheeks and



Research Letter | Dermatol Pract Concept. 2022;12(1):e2022015                                                                         1
Figure 1. (A) Diffuse hyperpigmentation of face including peri-ocular (heliotrope rash), zygomatic, and nasolabial folds. (B) Hyperpigmented
plaque over upper back (Shawl sign). (C) Hyperpigmented papules and macules over the knuckles (Gottron papule and Gottron sign). (D)
Hyperpigmented papules over radial aspect of index finger (mechanic’s hand). (E) Dermoscopy of heliotrope rash shows brown reticular
network, gray dots and globules (blue arrows) and linear out-of-focus vessels (blue stars) (DermLite DL4, polarized, ×10). (F) Dermoscopy
of Gottron papule shows white-to-pink structureless areas (blue arrows) and a reticular pigment network (blue star) (DermLite DL4, polar-
ized, ×10). (G) Histopathological examination shows an atrophic epidermis, basal cell vacuolation, melanophages, perivascular lymphocytic
infiltrate and the presence of focal mucin (hematoxylin and eosin, ×200). PAS stain shows the presence of mucin (inset).




2                                                                           Research Letter | Dermatol Pract Concept. 2022;12(1):e2022015
Figure 2. (A) Hyperpigmented macules over the forehead and erythema and edema over the malar area. (B) Hyperpigmented macules over
the lateral aspect of the cheek. (C) Dermoscopy shows brown reticular network (orange arrow), gray dots and globules (blue arrow), and
out-of-focus linear vessels (blue star) (DermLite DL4, polarized, ×10).



erythema and edema involving the malar area (Figure 2, A and            Dermoscopy may be helpful in the diagnosis of cuta-
B). Dermoscopy showed a reticular pigment network, brown-            neous features of dermatomyositis in darker skin. We also
to-gray dots and globules, and linear vessels (Figure 2D). The       tried to correlate dermoscopic findings with histopathology.
imaging, biochemical investigations, histopathology, and se-         This is the first report on dermoscopy of dermatomyositis in
rology was consistent with diagnosis of dermatomyositis.             darker skin to the best of our knowledge.

                                                                     Informed consent: Written informed consent for publication
Conclusion                                                           of her clinical details and clinical images was obtained from
                                                                     the patient.
Cutaneous features are essential and characteristic in the di-
agnosis of dermatomyositis. Dermoscopy of Gottron papule
has been described as a lump of surface scales and dotted            References
vessels [2]. Individuals with darker skin present with pre-
                                                                      1. Findlay AR, Goyal NA, Mozaffar T. An overview of polymyo-
dominant hyperpigmentation, that poses a diagnostic diffi-
                                                                         sitis and dermatomyositis. Muscle Nerve. 2015;51(5):638-656.
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due to basal cell damage and is seen as dots and globules on          2. Namiki T, Hashimoto T, Hanafusa T, Miura K, Yokozeki H. Case
dermoscopy. Linear out-of-focus vessels are due to epidermal             of dermatomyositis with Gottron papules and mechanic’s hand:
atrophy, and focal mucin deposition is seen as structureless             dermoscopic features. J Dermatol. 2018;45(1):e19-e20. DOI:
                                                                         10.1111/1346-8138.14072. PMID: 28971518.
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copy occurs due to melanization of the basal layer.




Research Letter | Dermatol Pract Concept. 2022;12(1):e2022015                                                                       3
