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Unusual Skin Rash

by Sue Hubbard, M.D.

One of the benefits of practicing in a large group is that you have a lot of “brains to pick” when a a patient presents with unusual case or confusing illness.

This happened just the other day when one of my partners saw a child with an unusual rash. The little girl had had the rash on her hands for a couple of weeks, but the rash was getting worse.

skinWhen her mother brought her in the doctor looked at the rash and said, “I think this is a rash that is usually seen with an illness called dermatomyositis”, but let me grab a few of the other doctors to look too. We all agreed that we thought her diagnosis was most likely correct (and kudos to her diagnostic skills) and then we each threw out a little bit of our information from our own “memory bank” about the disease.

Dermatomyositis is a muscle disease that is characterized by inflammation of the muscles and a skin rash. (Polymyositis is a similar condition but the symptoms occur without a skin rash). The cause of dermatomyositis is unknown, but it is an automimmune disease. In other words, your own immune system for some unknown reason is causing the inflammation of the muscles. Some experts think it may be brought on by a viral infection, and there are many studies underway to try and determine the etiology of the disease.

Like many diseases dermatomyositis seems to occur in certain age groups. It is most commonly seen in children between the ages of 5 -15, but may also present in adults between the ages of 40 -60. It is more common in females.

The most common symptom is the classic skin rash overlying the knuckles. There may also be a purplish rash on the upper eyelids. There is also muscle stiffness, and soreness. The muscle weakness may appear suddenly or may develop slowly over weeks to months. A child may complain of difficulty raising their arms over heads or getting up from a sitting position.

In this patients case she was referred to a pediatric rheumatologist for further evaluation and treatment.

That’s your daily dose for today.  We’ll chat again tomorrow.

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