Edema-purple spots on both upper eyelids

Introduction The typical skin lesions of dermatomyositis, the edematous purple-red spots on the upper eyelids, spread to the periorbital, and gradually spread to the V-shaped area of the face, neck and upper chest. The elbow and elbow, especially the metacarpophalangeal joint and the metatarsophalangeal joint, appear purple-red papules with telangiectasia, hypopigmentation, overlying fine scales, called Gottron (Gordon) sign or Grottron papules.

Cause

The cause is not known and may be related to multiple infections. It can even appear on the face like red pityriasis; it can be symmetrical polyarthritis of joint deformity. Multicentric reticular cell hyperplasia is characterized by a brownish or yellow papule or nodule (2 to 10 mm) with a hard texture on the hand (especially the dorsal joint) and the face. The papules can be fused with moss. It turns like a hairy pityriasis on the face; the serological examination of the disease has only mild cholesterol elevation and white/globulin inversion.

an examination

Related inspection

Ophthalmic examination of the eye and sacral area CT examination

(1) Muscle symptoms usually involve striated muscles, and sometimes smooth muscles and myocardium can be affected. Muscles can be invaded in any part, but often the muscles of the limbs are involved first, and the proximal muscles of the liver are more vulnerable than the distal ones. The scapula and pelvic muscles are usually the earliest, the upper arm and the thigh muscles are second, and the other parts of the muscle are second. Lesions are often symmetrical, and in a few cases the damage can be limited to one limb muscle group, or a single muscle or many muscles in a continuous episode, one after another; usually the patient feels weak, followed by muscle pain, pain and exercise pain; The force is reduced, presenting various motor dysfunctions and special postures. Symptoms may vary due to the number, severity, and location of muscle lesions. Generally, there are usually difficulty in raising the arm, head movement, or squatting, gait is poor, and sometimes it may be special due to impaired muscle strength. The posture, such as the head drooping, the shoulders leaning forward, etc., the heavy body can not move, or even turn over. When the pharynx, upper esophageal and ankle muscles are involved, hoarseness and dysphagia may occur; when the diaphragm and intercostal muscles are involved, dyspnea and dyspnea may occur; myocardial involvement may cause heart failure, and the eye muscles may undergo diplopia. The diseased muscle texture can be normal or soft, sometimes hard or firm after fibrosis, which can promote joint contracture to affect function. There are also reports of myasthenia gravis syndrome, ie painless muscle weakness, in activity. After the increase. The skin above the diseased muscle can be thickened or edematous.

(B) skin symptoms The skin damage of this disease is diverse, some are the first symptoms; some have certain specificity, which is helpful for diagnosis; some appear to be associated with visceral malignant tumors; some are related to prognosis. Skin lesions are often not parallel with muscle involvement. Sometimes skin lesions can be extensive and only mild myositis. On the contrary, there are severe muscle lesions with only mild skin lesions, and sometimes skin lesions reflect the extent of muscle lesions. Usually on the face of a special upper eyelids purple red spots, gradually diffusely spread the frontal forehead, cheeks, ears, neck and upper chest V-shaped area, the scalp and the back of the ear can also be involved. Closed-eye proximal sacral margin can be seen with obvious dilated dendritic capillaries. Occasionally, there are hair vessels with needle-sized sputum at the curved end; edema-like purple-red patches with certain degree of periorbital sinus around the eyelid have certain characteristics. Elbow and elbow knees, especially the metacarpophalangeal joints and interphalangeal joints, appear purple-red papules, plaques, and then atrophy, telangiectasia, hypopigmentation and overlying small scales, occasionally ulceration, called Gottron sign, also characteristic In the nail folds, visible telangiectasia and sputum can help to diagnose. In some cases, there may also be a rash on the trunk, which is diffuse or localized with dark red spots or papules. It is located in front of the sternum or between the scapular muscles or the back and back. It usually has no itching, pain, or paresthesia, but in a few cases it may be itchy. The damage is temporary, recurrent, and then merges with each other, and continues to retreat. There are fine scales on the upper surface, and erythema also appears in the oral mucosa.

In chronic cases, there may be multiple keratotic papules, spotted pigmentation, vasodilation, mild skin atrophy and hypopigmentation, called vascular atrophic heterochromic dermatomyositis, occasionally in heterochromatic On the basis of the disease-like rash, the rash is red or even brownish red, and the damage is extensive, especially on the head and face, like the appearance of drunkenness, accompanied by more dark brown, gray-brown needles, and pigmented spots. A pile of expanded capillaries, called malignant erythema, often suggest a malignant tumor.

In addition, there may be subcutaneous nodules, calcium deposits to discharge the skin to form a leaky tube, and sometimes in atypical cases only purple eye spots on the eyelids, one side or both sides or the base of the nose, or diffuse erythema or sputum in the scalp Despuration, hair loss, or urticaria, polymorphous erythema, reticular bluish, Raynaud phenomenon, etc., some cases are allergic to sunlight.

Differential diagnosis

Differential diagnosis of edematous purple-red spots in double upper eyelids:

The edematous purplish red spot of the double upper eyelid is mainly identified with lupus erythematosus, mixed connective tissue disease, and Sjogren's syndrome, Wegener's granulomatosis, multicentric reticulocyte hyperplasia, and other types of cutaneous vasculitis.

Lupus erythematosus: lupus erythematosus (sle) is an autoimmune disease involving multiple organs and multiple organs in the body, complicated clinical manifestations, and prolonged course of disease. Lupus erythematosus can be divided into two major categories: systemic lupus erythematosus (SLE) and discoid lupus erythematosus (DLE). Subacute cutaneous lupus erythematosus (SCLE) is a skin lesion between discoid lupus erythematosus and systemic lupus erythematosus.

Mixed connective tissue disease: mixed connective tissue disease (MCTD) is a rheumatic syndrome characterized by overlapping SLE, scleroderma, polymyositis or dermatomyositis and RA-like symptoms, with extremely high titers Circulating antinuclear antibodies, ie, antibodies against nuclear ribonucleoprotein, have the highest positive rate. Less renal involvement, good response to corticosteroids, good prognosis.

Sjogren's Syndrome: Sjogren's Syndrome Sjogren's syndrome is a chronic autoimmune disease mainly involving the exocrine glands such as lacrimal gland and salivary gland. It is also called autoimmune exocrine gland disease. Mainly manifested as dry cornea, conjunctivitis, xerostomia or other rheumatoid arthritis associated with rheumatoid arthritis, it can affect other systems such as respiratory, digestive, urinary, blood, nervous and muscle, Joints and the like cause damage to multiple systems and multiple organs. The disease can exist alone or in other autoimmune diseases. It is a primary Sjogren's syndrome (1SS), but secondary to rheumatoid arthritis, systemic scleroderma, systemic lupus erythematosus. Other autoimmune diseases are secondary Sjogren's syndrome (2SS).

Wegener's granulomatosis (WG) is a necrotizing granulomatous vasculitis that is an autoimmune disease. The lesions involve small arteries, veins and capillaries, occasionally involving the aorta. The pathology is characterized by inflammation of the vessel wall, mainly invading the upper and lower respiratory tract and the kidney. Wegener's granulomatosis usually has focal granulation of nasal mucosa and lung tissue. The inflammatory inflammation begins, and then progresses to diffuse necrotizing granulomatous inflammation of the blood vessels. Clinical manifestations of nasal and paranasal sinusitis, lung disease and progressive renal failure. It can also affect joints, eyes, skin, and can also invade the eyes, heart, nervous system and ears. Those without kidney involvement are referred to as localized Wegener granulomas.

Multicentric reticular cell hyperplasia: also known as lipid-like skin arthritis. Multicentric reticular cell hyperplasia is characterized by a brownish or yellow papule or nodule (2 to 10 mm) with a hard texture on the hand (especially the dorsal joint) and the face. The papules can be fused with moss. It can be seen in the face, even like red pityriasis; it can be symmetrical polyarthritis of joint deformity. The serological examination of the disease has only mild elevated cholesterol and white/globulin inversion.

Others need to be differentiated from seborrheic dermatitis and photosensitive dermatitis.

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