Heliotrope rash and 'V' sign in dermatomyositis.

Thirty five years lady presented with proximal muscle pain and weakness with generalized swelling of body and photosensitivity. On examination, patient had blue purple discoloration on upper eyelids with oedema (heliotrope rash) with flat red rash on fore head and cheeks (Fig. 1). Erythematous rash on neck and anterior chest was also present, V sign (Fig. 2). The diagnosis of dermatomyositis is considered definite in the presence of these characteristic rashes. Dilated capillary loops at the base of fingure nails which are characteristic of dermatomyositis, were also present in this case. Collagen profile, thyroid profile and scanning for malignancy was negative. EMG showed evidence of myopathy, muscle biopsy showed perifascicular atrophy confirming the diagnosis of dermatomyositis. Fig. 1 : Periorbital heliotrope rash