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This woman has this rash on her face and nail fold.

a. What do the pictures show?

b. What is the diagnosis?

c. What other ocular signs may be present?

d. What investigation would you perform?

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Answers:
 
This woman has this rash on her face and nail fold.

a. What do the pictures show?

    • Periorbital heliotrope (reddish-purple) rash.
    • Nail fold telangiectasia


b. What is the diagnosis?

Dermatomyositis.
c. What other ocular signs may be present?
    • Dry eyes
    • Episcleritis
    • Scleritis
    • Iritis
    • Ophthalmoplegia
    • Cotton wool spots on the retina


d. What investigation would you perform?

    • Confirm the diagnosis by performing muscle enzymes, electromyography, 

      • muscle and skin biopsy.
    • Search for an underlying cause which may be autoimmune 

      • or malignancy (25% of cases).
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