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Picture of the Month

Walter W. Tunnessen Jr, MD
Am J Dis Child. 1991;145(10):1161-1162. doi:10.1001/archpedi.1991.02160100093030.
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Denouement and Discussion 

Juvenile Dermatomyositis 

Manifestations  Juvenile dermatomyositis is a chronic, progressive, in flammatory muscle disease of childhood of unknown eti ology. A number of cutaneous changes are associated with this disorder that are extremely helpful in arriving at the correct diagnosis. The hands of these three children (Figs 1 through 3) show the erythematous, red-to-pink, hyperkeratotic papules, known as Gottron's sign, that are characteristic of this disorder. Although the cutaneous changes over the knuckles are most commonly elevated, the involved skin may be colorless and atrophie at times. The skin over the phalanges is generally spared of this rash.The facial rash associated with dermatomyositis may be confused with the rash of systemic lupus erythematosus. The malar areas may show a butterflylike band of erythema. The periorbital areas may also be enveloped by a similar erythema and sometimes appear edema tous. The rash may be precipitated


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