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Unilateral Gottron Papules in a Patient Following a Stroke Clinical Insights Into the Disease Mechanisms and Pathophysiology of Cutaneous Dermatomyositis

Drew J. B. Kurtzman, MD1; Allen Ho, MD1; Natalie A. Wright, MD1; Mitchell H. Rubenstein, MD1; Ruth Ann Vleugels, MD, MPH1
[+] Author Affiliations
1Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Dermatol. 2016;152(9):1062-1063. doi:10.1001/jamadermatol.2016.1537.
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This case report describes the occurrence of unilateral Gottron papules in a patient who had experienced a stroke.

Dermatomyositis (DM) is an autoimmune disorder with a characteristic pattern of skin and muscle disease. Preclinical studies have implicated abnormal stretch receptor signaling and external trauma as necessary components for the expression of certain cutaneous manifestations.1,2 These studies correlate with clinical findings, as DM preferentially affects UV-irradiated skin and frequently traumatized sites, such as over bony prominences on the hands and elbows. We evaluated a patient with residual hemiparesis from a stroke who developed cutaneous DM with a strikingly unilateral pattern on the hands: prominent disease on her functional side with sparing of her immobilized side. Our observation provides clinical evidence supporting the idea that external trauma, movement, and stretch may be requisite for the genesis of certain skin lesions in DM.

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Unilateral Gottron Papules in a Patient Following a Stroke

A, Hyperkeratotic erythematous papules (Gottron papules) on the proximal and distal interphalangeal joints of the functional left hand. B, The paralyzed right hand was unaffected.

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