5 The close relationship is thought to be a paraneoplastic process involving a link between oncogenesis and autoimmunity. This was confirmed in population based studies in Sweden4 and elsewhere.
UPPER CHEST DISCOMFORT AND RASH SKIN
Whitish skin nodules with stony consistency Roughening and fissuring of the skin on the palm and radial surface of the fingersĪbnormal capillary nailbed loops (alternating areas of dilatation and dropout and periungual erythema) Scaly and erythematous dermatitis on the dorsum of the hand over the metacarpophalangeal and interphalangeal joints Scaling and erythema of more than 90% of the surface area of the skinĮrythematous plaque affecting the posterior neck and shoulders (shawl sign) and/or the anterior neck and chest (V sign)
Violaceous upper eyelid eruption often associated with periorbital edema (Figure 1) Cutaneous signs of dermatomyositis 1–3 Sign postauricular and submental areas, nasolabial folds, above the upper eyelid and covered areas of the trunk and upper arms. On physical examination, careful attention should be paid to the distribution of the lesions and whether there is sparing of photoprotected areas, eg. To help discriminate between these two causes it is important to enquire if there is any seasonal pattern and about any exposure to potential photosensitisers. 1–3 Importantly, the V and shawl signs can be can be confused with other photodermatoses or sunburn. Several distinct rashes occur in dermatomyositis. This is a form of idiopathic inflammatory myopathies (IIM), which is a heterogeneous group of genetically determined autoimmune disorders that predominately target the skeletal musculature and/or skin. The likely diagnosis is classic dermatomyositis. The patient has the hallmark cutaneous manifestations of dermatomyositis combined with muscle weakness. What are the treatment options for this condition? Answer 1 Is there any relationship between this disorder and the diagnosis of a gastric tumour in this patient? Question 4 What are the typical skin findings in this disease? Question 3 What is the most likely diagnosis of the patient’s skin rash? Question 2 Gastroscopy revealed a stage IV gastric adenocarcinoma.įigure 4. Creatinine kinase was increased at 947 U/L (normal range 38–174 U/L). Skin biopsy showed mild atrophy of the epidermis with vacuolar changes in the basal keratinocyte layer and a perivascular lymphoid infiltrate in dermis.
Poikilodermatous skin changes include hyperpigmentation, telangiectasia and atrophy resulting in a mottled appearance. It had been treated for a time with topical steroids, but had responded poorly.Ĭlinical examination showed proximal muscle weakness and skin changes including erythematous violaceous plaques in the periorbital region associated with oedema of the eyelids and periorbital tissue ( Figure 1), confluent violaceous erythema of upper chest, neck and back with evidence of poikilodermatous skin changes ( Figure 2, 3) and periungual telangiectasia ( Figure 4).
On further questioning, he revealed that the rash had been present for 5 years and had previously been diagnosed as eczema. He also had a skin rash on his chest and face. A man, 77 years of age, presented with haematemesis, abdominal pain and increasing limb weakness.
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