The following symptoms and complaints may indicate dermatomyositis (muscle inflammation with skin involvement):
Main symptoms
Skin involvement:
- Head/face
- Alopecia (hair loss)
- Scaling in sun-exposed areas (forehead, auricles, walls and neck (shawl sign).
- Erythema (skin redness), slightly purple in color – this extends to the parts of the body exposed to sunlight (scalp, face, neck, neckline, upper part of the back, upper limbs) (= heliotropic erythema)
- Among other things, heliotropic (purple) erythema of the eyelids.
- Edema of the periorbital region (swelling lateral and below the orbit), also possible on the forehead and cheeks.
- Facial expression: tearful (hypomimia).
- Extremities
- Finger and metacarpophalangeal joints: symmetrically occurring Gottron papules (papules (nodular thickening of the skin) with a smooth surface and livid discoloration on the finger extensor sides) [pathognomonic sign, i.e., “clearly indicative of disease”]
- Atrophy (tissue atrophy)
- Erythema with scaling
- Rough and cracked fingers (“mechanic’s hands”)
- Teleangiectasia (vascular veins)
- Nails
- Hyperkeratosis (“thickening”) of the cuticle.
- Nail fold changes
- Thickening of the cuticle (so-called Keining sign).
- Teleangiectasia and splinter hemorrhages in the area of the nail fold.
- Trunk
- Atrophy (tissue loss)
- Hyper-/Depigmentation
- Poikilodermic foci (“multicolored skin”)
- Teleangiectasias (vascular veins)
Musculature related:
- Symmetrical muscle weakness (especially proximal extremity muscles/upper arms and thighs or shoulder/pelvic girdle).
- Muscle soreness myalgias (muscle pain).
- Sclerosis (hardening) and atrophy of shoulder/upper arm and pelvic/thigh muscles.
- Affected individuals are unable to raise their arms above their head and/or have difficulty climbing stairs, standing up.
- Notice: In the early stages of the disease, muscle involvement is often absent (pure amyopathic form) or more often clinically silent (clinical amyopathic DM).
Secondary symptoms
- Fatigue
- Fever
- Joint pain
Involvement of internal organs is possible:
- Esophagus (esophagus): dysphagia – in 30% of cases.
- Heart: interstitial myocarditis (inflammation of the heart muscle) – in 30% of cases; tachycardia (heartbeat too fast: > 100 beats per minute) and changes in the ECG are possible.
- Lungs: alveolitis (disease of the lung tissue and alveoli (alveoli)), fibrosis (pathological increase in connective tissue of the lungs) – in 30% of cases.
Typical constellation of symptoms sufficient for a tentative diagnosis:
- Lilac/purple erythema (redness of the skin).
- Reduction in strength
- Myalgia (muscle pain)