Heliotrope rash

Named after a deep purple flower, this is a heliotrope rash on the eyelids of a woman in her 70s (fig 1). These periorbital violaceous eruptions had worsened over three months and become oedematous. The patient had also become progressively more breathless on exertion over the past six weeks. High resolution computed tomography showed interstitial lung disease. Serum creatine kinase levels were raised, and an antibody test confirmed adiagnosis of anti-melanomadifferentiation-associated gene-5 (MDA-5) positive dermatomyositis. A heliotrope rash, which is often associated with periorbital oedema, is characteristic of dermatomyositis.1 Although many antibodies are linked to dermatomyositis, anti-MDA-5 antibodies are associated with rapidly progressive interstitial lung disease.2