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Correctly Diagnosing Dermatomyositis
Differentiating causes of facial erythema can be challenging. A recent article in the 76th Annual Meeting of the American Academy of Dermatology Conference Review discussed the importance of recognising clinical clues to correctly diagnose dermatomyositis. Wrong diagnosis leads to mismanagement, sometimes resulting in a fatal outcome for the patient.
Amyopathic dermatomyositis with no clinical muscle weakness and normal serum muscle enzyme levels
can be misdiagnosed as systemic lupus erythematosis.
Amyopathic dermatomyositis and cutaneous lupus erythematosis look similar clinically and cannot always be differentiated histologically. However, clinical differentiation is critical. The central facial erythema of dermatomyositis involves the naso-labial folds while in cutaneous lupus erythematosis the naso-labial folds are spared.
If dermatomyositis is incorrectly diagnosed as systemic lupus erythematosis, no search is made for an underlying malignancy. Interstitial lung disease associated with amyopathic dermatomyositis may also be missed if wrongly diagnosed as lupus erythematosis. Consequently, the patient may die of an underlying malignancy that occurs in 20-30 per cent of patients with dermatomyositis or interstitial lung disease.
The article stresses that clinical differentiation is therefore crucial.
Vleugels, RA. (February 2018.) Dermatomyositis. 76th Annual Meeting of the American Academy of Dermatology Conference Review. Research Review, Australia.
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