A woman with facial erythemaBMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2016 (Published 31 May 2018) Cite this as: BMJ 2018;361:k2016
- Ji Yang, associate professor of dermatology,
- Ming Li, professor of dermatology
- Correspondence to M Li,
A 69 year old woman presented with a two month history of an itchy facial rash. She had developed weakness of the proximal muscles of the extremities and shoulder girdle eight weeks after the onset of the rash. Examination revealed multiple violet maculopapules and patches on the forehead, upper eyelids, nose, and nasolabial grooves (fig 1). Dermatoscope examination showed nail fold hyperkeratosis with enlarged capillaries, dendritic tortuosity, and haemorrhages (fig 2). Laboratory examination revealed a creatine kinase level of 1045 units per litre (normal range 34-174 units per litre), and a creatine kinase MM level of 1008 units per litre (normal range 24-174 units per litre). A diagnosis of dermatomyositis was made. The patient was treated with intravenous methylprednisolone for 13 days, with the highest dose of 40 mg, followed by oral prednisone therapy, with resolution of the rash and muscle weakness at six month follow-up.
Facial erythema is an early sign of dermatomyositis. Differential diagnoses would include allergic contact dermatitis, photodermatosis, lupus, rosacea, and seborrhoeic dermatitis.
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