Physician, beware! The deckchair sign can be seen in dermatomyositis

The “deck‐chair sign” as an early diagnostic clue in dermatomyositis

“…Interestingly, all patients eventually developed classic DM cutaneous findings and biomarkers, which confirmed the diagnosis. Unlike the previously reported amyopathic dermatomyositis case, 5 our cases suggested that deck‐chair sign could be seen in both classic and amyopathic dermatomyositis, although it seems to first develop during a clinically amyopathic state. Pathologically, all cases that presented with deck‐chair sign showed interface dermatitis on biopsy and responded well to hydroxychloroquine and/or methotrexate.…”

Deck‐chair sign: unreserved

“…6 Others have suggested that the skin sparing is a result of physical compression leading to a decreased blood flow in small blood vessels at the skin folds, which diminishes local inflammation. 5 In conclusion, our case demonstrates that the DCS should be unreserved for PEO as it is not a unique clinical finding for this condition. PRP should be added to the differential diagnosis of conditions capable of displaying the DCS.…”

“…First described in 1984, the DCS was initially believed to be unique to papuloerythroderma of Ofuji (PEO), and its use was therefore commonly reserved for this condition. 1 However, over recent decades, the DCS has been described in a variety of skin diseases and reactions, [2][3][4] including dermatomyositis as described by Wernham et al 5 We report the first case, to our knowledge, of pityriasis rubra pilaris (PRP) displaying the DCS.…”

“…In leprosy, the DCS was thought to occur due to the mycobacterium sparing of relatively warmer areas of the body 6 . Others have suggested that the skin sparing is a result of physical compression leading to a decreased blood flow in small blood vessels at the skin folds, which diminishes local inflammation 5 …”

Cutaneous manifestations in idiopathic inflammatory myopathies

“…Many diseases can produce this pattern, but it is very characteristic in Ofuji papuloerythroderma. It could be the first sign of DM and precede classic DM skin findings and even laboratory tests 9,24,25 .…”