Gottron papules in the skin of color

A 7-year-old girl presented with difficulty in climbing stairs and multiple skin-colored raised lesions on the dorsum of the hands, elbows, and knees for 1.5 years, without systemic symptoms. On examination, multiple skin colored flat-topped papules were noted over the metacarpophalangeal, interphalangeal joints [Figure 1], elbows, knees, and flexor wrists, along with brownish pigmented scaly macular erythema on the upper eyelids without periorbital edema. Biochemical investigations revealed elevated creatine kinase (162 IU/L) and lactate dehydrogenase levels (375 IU/L). Magnetic resonance imaging confirms evidence of myositis in the bilateral gluteus, thighs, and legs. Based on the history, clinical findings, and laboratory results, a diagnosis of juvenile dermatomyositis with Gottron’s papules was made.

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Figure 1:

Skin-colored flat-topped papules over interphalangeal and metacarpophalangeal joints of both hands (Please note that the pink color on the nails is due to nail polish).

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Gottron papules, first described by Heinrich Adolf, are classically red to violet flat-topped papules on the dorsum of the metacarpophalangeal and interphalangeal joints. They may show mild scaling or ulceration and often heal with atrophy or scarring.^[1] However, in patients with skin of color, the violaceous hue may be less apparent or obscured, creating a diagnostic challenge.