case_images: PMC11188451_01
case_images: Select cutaneous manifestations of dermatomyositis in reported patients. Note Gottron sign/papules (A), "ragged" cuticular hypertrophy in Case 2 (B), and typical violaceous erythema, scale and "sleeve" sign in Case 3 (C). Cases 1-3 also had a fur stole and turtleneck sign. Those with a halter-back/reflected shawl sign demonstrate Gottron papules (Cases 4 and 5, D, E) and V-sign (Case 6, F). Case 6 also had erosion and blisters (not shown).
case_images: fimmu-15-1400575-g001.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g001.jpg
case_images: f1
case_images: Skin examination revealed diffuse erythema involving the upper chest (V-neck,  Figure 1F ), outer arms (sleeve sign), outer thighs (holster sign), and abdomen.
case_images: "Fur stole and turtle neck" and "Halter-back/reflected shawl" signs. Note the horizontally oriented sharply demarcated involvement of the upper chest and anterior shoulders (fur stole pattern) with diffuse involvement of the anterior neck (turtleneck pattern) in Cases 1-3 (A-C). Observe the varied primary morphologies including atrophic hyperpigmentation with focal depigmentation (A), macular hyperpigmentation (Case 2, B), and thin hyperkeratotic, hyperpigmented, and violaceous plaques (Case 3, C). Halter-back/reflected shawl sign (Cases 4-6, D-F) exhibits upper and lower back involvement with distinct sparing of the mid-back. Again, note the variable primary morphologies including psoriasiform plaques (Case 4, D), macular hyperpigmentation/red-brown erythema (Case 5, E), and macular diffuse and flagellate erythema (Case 6, F). This latter patient has antibodies against NXP-2 and SSA 52 kd.
case_images: fimmu-15-1400575-g002.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g002.jpg
case_images: f2
case_images: Striking flagellate and diffuse erythema were noted to involve the upper back and lower back with sparing of the mid-back (HBS/RSS,  Figure 2F ).
case_images: Histopathologic findings in "Fur stole and turtle neck" and "Halter-back/reflected shawl" signs. All cases demonstrated interface dermatitis. Note the hyperkeratosis, epidermal atrophy, and basal vacuolar change in biopsies from Cases 1, 2, and 4 (A, B, D). Apoptotic keratinocytes are visualized (B inset, D, E). Case 3 (C) has mild epidermal hyperplasia and a more prominent lymphocytic infiltrate while Case 6 (F) demonstrates massive papillary dermal edema and increased dermal mucin, highlighted by Alcian blue (F, inset). (A-E), Hematoxylin and eosin (H&E) x200; D inset, Periodic acid Schiff (PAS) x400; F, H&E x100; F inset, Alcian Blue x200.
case_images: fimmu-15-1400575-g003.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g003.jpg
case_images: f3
case_images: Skin biopsy (arm) revealed basal layer vacuolar change, massive papillary dermal edema with subepidermal clefting, a sparse superficial perivascular lymphocytic infiltrate, and Alcian blue-positive increased dermal mucin ( Figure 3F ).
case_images: PMC11188451_02
case_images: Select cutaneous manifestations of dermatomyositis in reported patients. Note Gottron sign/papules (A), "ragged" cuticular hypertrophy in Case 2 (B), and typical violaceous erythema, scale and "sleeve" sign in Case 3 (C). Cases 1-3 also had a fur stole and turtleneck sign. Those with a halter-back/reflected shawl sign demonstrate Gottron papules (Cases 4 and 5, D, E) and V-sign (Case 6, F). Case 6 also had erosion and blisters (not shown).
case_images: fimmu-15-1400575-g001.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g001.jpg
case_images: f1
case_images: Skin examination revealed diffuse erythema involving the upper chest (V-neck,  Figure 1F ), outer arms (sleeve sign), outer thighs (holster sign), and abdomen.
case_images: "Fur stole and turtle neck" and "Halter-back/reflected shawl" signs. Note the horizontally oriented sharply demarcated involvement of the upper chest and anterior shoulders (fur stole pattern) with diffuse involvement of the anterior neck (turtleneck pattern) in Cases 1-3 (A-C). Observe the varied primary morphologies including atrophic hyperpigmentation with focal depigmentation (A), macular hyperpigmentation (Case 2, B), and thin hyperkeratotic, hyperpigmented, and violaceous plaques (Case 3, C). Halter-back/reflected shawl sign (Cases 4-6, D-F) exhibits upper and lower back involvement with distinct sparing of the mid-back. Again, note the variable primary morphologies including psoriasiform plaques (Case 4, D), macular hyperpigmentation/red-brown erythema (Case 5, E), and macular diffuse and flagellate erythema (Case 6, F). This latter patient has antibodies against NXP-2 and SSA 52 kd.
case_images: fimmu-15-1400575-g002.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g002.jpg
case_images: f2
case_images: Striking flagellate and diffuse erythema were noted to involve the upper back and lower back with sparing of the mid-back (HBS/RSS,  Figure 2F ).
case_images: Histopathologic findings in "Fur stole and turtle neck" and "Halter-back/reflected shawl" signs. All cases demonstrated interface dermatitis. Note the hyperkeratosis, epidermal atrophy, and basal vacuolar change in biopsies from Cases 1, 2, and 4 (A, B, D). Apoptotic keratinocytes are visualized (B inset, D, E). Case 3 (C) has mild epidermal hyperplasia and a more prominent lymphocytic infiltrate while Case 6 (F) demonstrates massive papillary dermal edema and increased dermal mucin, highlighted by Alcian blue (F, inset). (A-E), Hematoxylin and eosin (H&E) x200; D inset, Periodic acid Schiff (PAS) x400; F, H&E x100; F inset, Alcian Blue x200.
case_images: fimmu-15-1400575-g003.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g003.jpg
case_images: f3
case_images: Skin biopsy (arm) revealed basal layer vacuolar change, massive papillary dermal edema with subepidermal clefting, a sparse superficial perivascular lymphocytic infiltrate, and Alcian blue-positive increased dermal mucin ( Figure 3F ).
case_images: PMC11188451_03
case_images: Select cutaneous manifestations of dermatomyositis in reported patients. Note Gottron sign/papules (A), "ragged" cuticular hypertrophy in Case 2 (B), and typical violaceous erythema, scale and "sleeve" sign in Case 3 (C). Cases 1-3 also had a fur stole and turtleneck sign. Those with a halter-back/reflected shawl sign demonstrate Gottron papules (Cases 4 and 5, D, E) and V-sign (Case 6, F). Case 6 also had erosion and blisters (not shown).
case_images: fimmu-15-1400575-g001.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g001.jpg
case_images: f1
case_images: Skin examination revealed diffuse erythema involving the upper chest (V-neck,  Figure 1F ), outer arms (sleeve sign), outer thighs (holster sign), and abdomen.
case_images: "Fur stole and turtle neck" and "Halter-back/reflected shawl" signs. Note the horizontally oriented sharply demarcated involvement of the upper chest and anterior shoulders (fur stole pattern) with diffuse involvement of the anterior neck (turtleneck pattern) in Cases 1-3 (A-C). Observe the varied primary morphologies including atrophic hyperpigmentation with focal depigmentation (A), macular hyperpigmentation (Case 2, B), and thin hyperkeratotic, hyperpigmented, and violaceous plaques (Case 3, C). Halter-back/reflected shawl sign (Cases 4-6, D-F) exhibits upper and lower back involvement with distinct sparing of the mid-back. Again, note the variable primary morphologies including psoriasiform plaques (Case 4, D), macular hyperpigmentation/red-brown erythema (Case 5, E), and macular diffuse and flagellate erythema (Case 6, F). This latter patient has antibodies against NXP-2 and SSA 52 kd.
case_images: fimmu-15-1400575-g002.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g002.jpg
case_images: f2
case_images: Striking flagellate and diffuse erythema were noted to involve the upper back and lower back with sparing of the mid-back (HBS/RSS,  Figure 2F ).
case_images: Histopathologic findings in "Fur stole and turtle neck" and "Halter-back/reflected shawl" signs. All cases demonstrated interface dermatitis. Note the hyperkeratosis, epidermal atrophy, and basal vacuolar change in biopsies from Cases 1, 2, and 4 (A, B, D). Apoptotic keratinocytes are visualized (B inset, D, E). Case 3 (C) has mild epidermal hyperplasia and a more prominent lymphocytic infiltrate while Case 6 (F) demonstrates massive papillary dermal edema and increased dermal mucin, highlighted by Alcian blue (F, inset). (A-E), Hematoxylin and eosin (H&E) x200; D inset, Periodic acid Schiff (PAS) x400; F, H&E x100; F inset, Alcian Blue x200.
case_images: fimmu-15-1400575-g003.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g003.jpg
case_images: f3
case_images: Skin biopsy (arm) revealed basal layer vacuolar change, massive papillary dermal edema with subepidermal clefting, a sparse superficial perivascular lymphocytic infiltrate, and Alcian blue-positive increased dermal mucin ( Figure 3F ).
case_images: PMC11188451_04
case_images: Select cutaneous manifestations of dermatomyositis in reported patients. Note Gottron sign/papules (A), "ragged" cuticular hypertrophy in Case 2 (B), and typical violaceous erythema, scale and "sleeve" sign in Case 3 (C). Cases 1-3 also had a fur stole and turtleneck sign. Those with a halter-back/reflected shawl sign demonstrate Gottron papules (Cases 4 and 5, D, E) and V-sign (Case 6, F). Case 6 also had erosion and blisters (not shown).
case_images: fimmu-15-1400575-g001.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g001.jpg
case_images: f1
case_images: Skin examination revealed diffuse erythema involving the upper chest (V-neck,  Figure 1F ), outer arms (sleeve sign), outer thighs (holster sign), and abdomen.
case_images: "Fur stole and turtle neck" and "Halter-back/reflected shawl" signs. Note the horizontally oriented sharply demarcated involvement of the upper chest and anterior shoulders (fur stole pattern) with diffuse involvement of the anterior neck (turtleneck pattern) in Cases 1-3 (A-C). Observe the varied primary morphologies including atrophic hyperpigmentation with focal depigmentation (A), macular hyperpigmentation (Case 2, B), and thin hyperkeratotic, hyperpigmented, and violaceous plaques (Case 3, C). Halter-back/reflected shawl sign (Cases 4-6, D-F) exhibits upper and lower back involvement with distinct sparing of the mid-back. Again, note the variable primary morphologies including psoriasiform plaques (Case 4, D), macular hyperpigmentation/red-brown erythema (Case 5, E), and macular diffuse and flagellate erythema (Case 6, F). This latter patient has antibodies against NXP-2 and SSA 52 kd.
case_images: fimmu-15-1400575-g002.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g002.jpg
case_images: f2
case_images: Striking flagellate and diffuse erythema were noted to involve the upper back and lower back with sparing of the mid-back (HBS/RSS,  Figure 2F ).
case_images: Histopathologic findings in "Fur stole and turtle neck" and "Halter-back/reflected shawl" signs. All cases demonstrated interface dermatitis. Note the hyperkeratosis, epidermal atrophy, and basal vacuolar change in biopsies from Cases 1, 2, and 4 (A, B, D). Apoptotic keratinocytes are visualized (B inset, D, E). Case 3 (C) has mild epidermal hyperplasia and a more prominent lymphocytic infiltrate while Case 6 (F) demonstrates massive papillary dermal edema and increased dermal mucin, highlighted by Alcian blue (F, inset). (A-E), Hematoxylin and eosin (H&E) x200; D inset, Periodic acid Schiff (PAS) x400; F, H&E x100; F inset, Alcian Blue x200.
case_images: fimmu-15-1400575-g003.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g003.jpg
case_images: f3
case_images: Skin biopsy (arm) revealed basal layer vacuolar change, massive papillary dermal edema with subepidermal clefting, a sparse superficial perivascular lymphocytic infiltrate, and Alcian blue-positive increased dermal mucin ( Figure 3F ).
case_images: PMC11188451_05
case_images: Select cutaneous manifestations of dermatomyositis in reported patients. Note Gottron sign/papules (A), "ragged" cuticular hypertrophy in Case 2 (B), and typical violaceous erythema, scale and "sleeve" sign in Case 3 (C). Cases 1-3 also had a fur stole and turtleneck sign. Those with a halter-back/reflected shawl sign demonstrate Gottron papules (Cases 4 and 5, D, E) and V-sign (Case 6, F). Case 6 also had erosion and blisters (not shown).
case_images: fimmu-15-1400575-g001.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g001.jpg
case_images: f1
case_images: Skin examination revealed diffuse erythema involving the upper chest (V-neck,  Figure 1F ), outer arms (sleeve sign), outer thighs (holster sign), and abdomen.
case_images: "Fur stole and turtle neck" and "Halter-back/reflected shawl" signs. Note the horizontally oriented sharply demarcated involvement of the upper chest and anterior shoulders (fur stole pattern) with diffuse involvement of the anterior neck (turtleneck pattern) in Cases 1-3 (A-C). Observe the varied primary morphologies including atrophic hyperpigmentation with focal depigmentation (A), macular hyperpigmentation (Case 2, B), and thin hyperkeratotic, hyperpigmented, and violaceous plaques (Case 3, C). Halter-back/reflected shawl sign (Cases 4-6, D-F) exhibits upper and lower back involvement with distinct sparing of the mid-back. Again, note the variable primary morphologies including psoriasiform plaques (Case 4, D), macular hyperpigmentation/red-brown erythema (Case 5, E), and macular diffuse and flagellate erythema (Case 6, F). This latter patient has antibodies against NXP-2 and SSA 52 kd.
case_images: fimmu-15-1400575-g002.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g002.jpg
case_images: f2
case_images: Striking flagellate and diffuse erythema were noted to involve the upper back and lower back with sparing of the mid-back (HBS/RSS,  Figure 2F ).
case_images: Histopathologic findings in "Fur stole and turtle neck" and "Halter-back/reflected shawl" signs. All cases demonstrated interface dermatitis. Note the hyperkeratosis, epidermal atrophy, and basal vacuolar change in biopsies from Cases 1, 2, and 4 (A, B, D). Apoptotic keratinocytes are visualized (B inset, D, E). Case 3 (C) has mild epidermal hyperplasia and a more prominent lymphocytic infiltrate while Case 6 (F) demonstrates massive papillary dermal edema and increased dermal mucin, highlighted by Alcian blue (F, inset). (A-E), Hematoxylin and eosin (H&E) x200; D inset, Periodic acid Schiff (PAS) x400; F, H&E x100; F inset, Alcian Blue x200.
case_images: fimmu-15-1400575-g003.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g003.jpg
case_images: f3
case_images: Skin biopsy (arm) revealed basal layer vacuolar change, massive papillary dermal edema with subepidermal clefting, a sparse superficial perivascular lymphocytic infiltrate, and Alcian blue-positive increased dermal mucin ( Figure 3F ).
case_images: PMC11188451_06
case_images: Select cutaneous manifestations of dermatomyositis in reported patients. Note Gottron sign/papules (A), "ragged" cuticular hypertrophy in Case 2 (B), and typical violaceous erythema, scale and "sleeve" sign in Case 3 (C). Cases 1-3 also had a fur stole and turtleneck sign. Those with a halter-back/reflected shawl sign demonstrate Gottron papules (Cases 4 and 5, D, E) and V-sign (Case 6, F). Case 6 also had erosion and blisters (not shown).
case_images: fimmu-15-1400575-g001.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g001.jpg
case_images: f1
case_images: Skin examination revealed diffuse erythema involving the upper chest (V-neck,  Figure 1F ), outer arms (sleeve sign), outer thighs (holster sign), and abdomen.
case_images: "Fur stole and turtle neck" and "Halter-back/reflected shawl" signs. Note the horizontally oriented sharply demarcated involvement of the upper chest and anterior shoulders (fur stole pattern) with diffuse involvement of the anterior neck (turtleneck pattern) in Cases 1-3 (A-C). Observe the varied primary morphologies including atrophic hyperpigmentation with focal depigmentation (A), macular hyperpigmentation (Case 2, B), and thin hyperkeratotic, hyperpigmented, and violaceous plaques (Case 3, C). Halter-back/reflected shawl sign (Cases 4-6, D-F) exhibits upper and lower back involvement with distinct sparing of the mid-back. Again, note the variable primary morphologies including psoriasiform plaques (Case 4, D), macular hyperpigmentation/red-brown erythema (Case 5, E), and macular diffuse and flagellate erythema (Case 6, F). This latter patient has antibodies against NXP-2 and SSA 52 kd.
case_images: fimmu-15-1400575-g002.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g002.jpg
case_images: f2
case_images: Striking flagellate and diffuse erythema were noted to involve the upper back and lower back with sparing of the mid-back (HBS/RSS,  Figure 2F ).
case_images: Histopathologic findings in "Fur stole and turtle neck" and "Halter-back/reflected shawl" signs. All cases demonstrated interface dermatitis. Note the hyperkeratosis, epidermal atrophy, and basal vacuolar change in biopsies from Cases 1, 2, and 4 (A, B, D). Apoptotic keratinocytes are visualized (B inset, D, E). Case 3 (C) has mild epidermal hyperplasia and a more prominent lymphocytic infiltrate while Case 6 (F) demonstrates massive papillary dermal edema and increased dermal mucin, highlighted by Alcian blue (F, inset). (A-E), Hematoxylin and eosin (H&E) x200; D inset, Periodic acid Schiff (PAS) x400; F, H&E x100; F inset, Alcian Blue x200.
case_images: fimmu-15-1400575-g003.jpg
case_images: PMC11188451_06_fimmu-15-1400575-g003.jpg
case_images: f3
case_images: Skin biopsy (arm) revealed basal layer vacuolar change, massive papillary dermal edema with subepidermal clefting, a sparse superficial perivascular lymphocytic infiltrate, and Alcian blue-positive increased dermal mucin ( Figure 3F ).