Dr. Jennie Clarke emphasizes points from her lecture "Pearls To Help Distinguish Autoimmune Cutaneous Manifestations" on Saturday, November 11, 2023, at the 4th Annual Elevate-Derm PA/NP Conference in Coachella Valley, CA.
In this video
Dr. Clarke tackles a common clinical scenario: the patient who comes in with facial redness and sun sensitivity asking, "Do I have lupus?" As she points out, both lupus and dermatomyositis produce central facial redness and photosensitivity, so the clinical exam is really the only way to make the distinction. Her key morphologic clue is the nasolabial folds — in lupus the butterfly rash shows "very strict sparing of the nasolabial folds," leaving that sun-protected crease looking normal, whereas dermatomyositis crosses right over and involves them.
She also elaborates on the heliotrope rash — purple, scaly patches on the eyelids that can come with eyelid edema, a feature far more characteristic of dermatomyositis than lupus. And while the heliotrope rash is classically thought of as an eyelid finding, Dr. Clarke notes it "really likes the nasal bridge too," where it can actually be more prominent than on the eyelids themselves.
- Facial redness plus sun sensitivity should prompt thoughts of lupus, but dermatomyositis shares both features — the clinical exam is the way to tell them apart.
- Lupus spares the nasolabial folds (the sun-protected crease looks normal); dermatomyositis crosses right over and involves them.
- Eyelid edema accompanying periorbital redness points toward dermatomyositis rather than lupus.
- The heliotrope rash — purple, scaly patches with eyelid edema — often extends onto the nasal bridge, where it can be more prominent than on the eyelids.
