Juvenile dermatomyositis: a case study.

38 Volume 25 Number 1 over the bridge of the nose along with a purplish rash over her eyelids that had been present for approximately 6 to 8 weeks. In addition, the child had a pruritic bumpy rash on her upper arms, elbows, knuckles, and knees and an elongated purplish area on her right shin. The child’s mother stated, “The facial rash seems to worsen after she has been in the sun.” The mother also reported that the child had several “bowel accidents” a day, that her stool is “liquid,” and that she “frequently vomits after eating a large meal and then resumes eating 15 to 30 minutes later.” The rash first developed after swimming for several hours on a summer day. The erythematous facial rash presented more on the right side than the left and bilaterally on her eyelids. Sun exposure made the rashworse. The rashwas associatedwith pruritus. Topical treatment with diphenhydramine and over-thecounter hydrocortisone did not improve the rash. The patient was seen multiple times by a pediatrician, who prescribed topical steroids for eczema. This treatment was ineffective and the rash continued to progress in severity, extending to the elbows, knees, anterior aspect of both legs, and to the lateral and medial malleolus. The rash becamemore erythematous and scaly with excoriations as a result of itching. A dermatology consultation was arranged.