Erythroderma as a presenting feature of dermatomyositis: case-based review

Erythroderma is an extensive, scaly erythema, involving more than 90% of the body surface area, and may be life-threatening. Dermatomyositis (DM) has been reported as a rare aetiology for erythroderma. However, the erythroderma itself would potentially mask the pathognomonic cutaneous lesions like the confluent erythema, heliotrope rash, and Gottron's sign of DM, leading to diagnostic dilemmas and potential delay in diagnosis. Here, we report a 23-year-old female with DM who had initially presented with erythroderma. Her cutaneous manifestations preceded the onset of clinical muscle weakness. She was successfully treated with systemic corticosteroids and azathioprine and is in clinical remission at 18 months follow-up. We review the literature for similar cases and found that there have been less than ten cases of erythroderma in dermatomyositis reported to date. This review enables us to explore this rare manifestation of DM. We discuss the presentation, clinical approach and decision-making in such cases.