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Digital Pulp Ulcerations and Inverse Gottron Papules in Melanoma Differentiation-Associated Gene 5-Related Dermatomyositis.

D ermatomyositis presents as an inflammatory myopathy with cutaneous findings. Significant heterogeneity in severity of disease and extramuscular manifestations exists and can be predicted by the presence of myositis-specific autoantibodies. A 54-year-old African American man reported 2 months of progressive proximal muscle weakness, manifesting as difficulty with rising from a seated position. In addition, he reported recent onset of dysphagia, arthritis of his hands and feet, and dyspnea on exertion. On examination, periungal skin cracking, digital pulp ulcerations, and inverse Gottron papules were noted (Figs. 1 and 2). Diffuse muscular atrophy and synovitis at the metacarpophalangeal, proximal interphalangeal, and metatarsophalangeal joints bilaterally were noted on examination. His creatine kinase was 664 U/mL, and he was positive for the anti–melanoma differentiation-associated gene 5 antibody (anti-MDA5). Magnetic resonance imaging of his lower extremities demonstrated muscle edema and gadolinium enhancement in multiple muscle groups. High-resolution computed