DM also may include head and neck dermatologic manifestations that can have considerable diagnostic importance. Among these is the virtually pathognomonic heliotrope rash (Fig. 7). This lesion, which leads to edema and discoloration of the eyelids, takes its name from the deep purple flower of the heliotrope plant, although the lesion may vary in color from pink to red to brown. DM may also lead to an erythematous rash on many locations on the body, including the face and neck (Fig. 8). Nasal septal perforation has been
reported in DM (23). Two case reports have been made of children with chondrodermatitis nodularis helicis and DM (24,25).
Inflammatory myositis in both DM and PM can prominently involve musculature in the head and neck area. About one-half of patients experience weakness of the neck flexors; ocular and facial muscles are virtually never involved. Weakness of the striated oropharyngeal muscles can result in dysphonia and difficulty swallowing. Dysphagia can also result from esophageal dysmotility or cricoarytenoid sphincter muscle hypertrophy leading to obstruction (26).
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