Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2023;13(2):e2023126 1 Inverse Gottron Papules in Dermatomyositis Maria-Elena Gimeno-Ribes1, Daniel Morgado-Carrasco1 1 Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain Citation: Gimeno-Ribes ME, Morgado-Carrasco D. Inverse Gottron Papules in Dermatomyositis. Dermatol Pract Concept. 2023;13(2):e2023126. DOI: https://doi.org/10.5826/dpc.1302a126 Accepted: September 26, 2022; Published: April 2023 Copyright: ©2023 Gimeno-Ribes et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Daniel Morgado-Carrasco, Dermatology Department, Hospital Clínic de Barcelona, Spain. Tel. (+34) 935 464 710 Fax (+34) 935 464 729 E-mail: morgadodaniel8@gmail.com Case Presentation An otherwise healthy 40-year-old woman, working as a secretary, presented to our clinic complaining of photo- sensitivity and muscle weakness. Physical examination revealed facial erythematous desquamative plaques, and non-tender pale hyperkeratotic papules over the palmar as- pect of the interphalangeal joints (Figure 1). She was sent to the Rheumatology department, where a muscle biopsy was performed, confirming the diagnosis of Dermatomyo- sitis. An autoimmunity panel showed positivity for antiMi2 antibodies. All other autoantibodies were negative. No ma- lignancies were found on imaging tests. A high-resolution computed tomography of the lungs showed no pathologic findings. Prednisone 30 mg/day, methotrexate 15 mg/week and hydroxychloroquine 400 mg/day were started, with resolution of muscular symptomatology after 2 months. Facial cutaneous manifestations and photosensitivity showed only partial response. Palmar papules persisted during the follow-up (12 months), and antiMi2 antibodies remained positive. Teaching Point Dermatomyositis can be associated with a wide range of cutaneous manifestations. Inverse Gottron papules are ker- atotic papules located on the flexor aspects of the fingers (distal and proximal interphalangeal joints, and metacarpo- phalangeal joints), and are an infrequently reported clinical sign of dermatomyositis [1,2]. In some case series, an asso- ciation between inverse Gottron papules and antiMDA5 an- tibodies or Juvenile dermatomyositis has been reported, and Figure 1. Inverse Gottron papules. Pale hyperkeratotic papules over the palmar aspect of interphalangeal joints. 2 Image Letter | Dermatol Pract Concept. 2023;13(2):e2023126 patients with this clinical sign might have an increased risk of developing interstitial lung disease, and a worse progno- sis [1,2]. However, there is scarce literature regarding this manifestation, and clinical implications remain unclear and should be further assessed. Regarding physiopathology, in- verse Gottron papules may be induced by keratinocyte dam- age secondary to mechanical injury [1]. Inverse Gottron papules are an infrequent manifestation of dermatomyositis. Recognizing this clinical sign can help in the diagnosis of this disorder. References 1. Irie K, Matsumura N, Hoshi M, Yamamoto T. Inverse Gottron’s papules in patients with dermatomyositis: an underrecognized but important sign for interstitial lung disease. Int J Dermatol. 2021;60(2):e62-e65. DOI: 10.1111/ijd.15204. PMID: 32970839. 2. Anjani G, Govindarajan S, Sudhakar M, Chaudhary H, Rawat A, Kumar Jindal A. Catch the thief by its marks: inverse Gottron papules, interstitial lung disease, anti MDA-5 antibody positivity in juvenile dermatomyositis. Rheumatology. 2021;60(2):e56– e58. DOI: 10.1093/rheumatology/keaa433. PMID: 32888028.