Discordance of skin and muscle involvement in dermatomyositis

The skin manifestations of dermatomyositis infrequently occur without the myositis. A 24-year-old woman presented with concordance of the skin and muscle components of dermatomyositis, followed by a remission of the myositis with a persistence of significant rash for 17 years, finally presenting with a flare of both skin and muscle components together. Clinicians should be alert to the recurrence of an underlying myositis at any time.