Dermatomyositis and flagellate erythema

Abstract

Flagellate erythema, described by Moulin in 1970 as reminiscent of the lesions produced by flogging and by other authors as zebra-like lesions, was noted first in association with bleomycin treatment, but later occasionally reported in relationship with dermatomyositis, mostly from Japan. It is characterized by linear, erythematous, cutaneous streaks, pruriginous or painful, arising on an oedematous background and disappearing spontaneously over several weeks. So far, fewer than five cases have been reported in association with dermatomyositis, but we now present a further one.

Zebra Stripes in Dermatomyositis: Case Report and Review of Flagellate Erythema‐Associated Dermatomyositis

“…Interestingly, the risk of malignancy is increased during the first 3-5 years after dermatomyositis onset with a reported frequency of 9-32%. 15 In our review, 40% (6/15) of cases had concurrent malignancies (Table 1), [2][3][4][5][6][7][8][9][10][11][12] which may be slightly higher than the reported frequency of malignancy in dermatomyositis. 15 Of note, five of the six patients with a malignancy were male.…”

“…Tests for other rheumatologic antibodies were negative (Table 1). [2][3][4][5][6][7][8][9][10][11][12] Correlation of the clinical and laboratory findings established the diagnosis of amyopathic dermatomyositis with flagellate erythema.…”

“…7,14 In the cases of dermatomyositis-associated flagellate erythema described, classic features such as heliotrope erythema and Gottron's papules were present in all cases except one. [2][3][4][5][6][7][8][9][10][11][12] A total of 60% of cases (9/15) were seen in males, while the ages of females and males exhibit a similar distribution (Table 1). [2][3][4][5][6][7][8][9][10][11][12] To date, only one case of juvenile dermatomyositis has been described in association with flagellate erythema.…”

“…3 While pruritus was reported in 20% (3/15) of cases, none of the cases exhibited features of dermatographism (Table 1). [2][3][4][5][6][7][8][9][10][11][12] To date, three cases (3/15, 20%) of flagellate erythemaassociated amyopathic dermatomyositis have been described in the literature, 9,11,12 although two other cases (2/15, 13%), including our current case, may represent clinically amyopathic dermatomyositis (CADM) 10 (Table 1). [2][3][4][5][6][7][8][9][10][11][12] Two of the three amyopathic patients tested positive for antimelanoma differentiation-associated protein 5 (CADM-140) 9 and antitranscriptional intermediary factor 1 gamma (TIF-1c), 12 respectively.…”

Erstmanifestation eines systemischen Lupus erythematodes unter dem Bild flagellatenförmiger Erytheme in der Glutealregion

“…Über das Auftreten flagellatenförmiger Erytheme wird bei einigen Fällen von Dermatomyositis [4,5,8,9], nach Bleomycin-Therapie [1,2] und nach dem Genuss des ungekochten Speisepilzes Lentinus edodes bei der so genannten Shiitake-Dermatitis [3,7] berichtet.…”