History: Dermatomyositis typically begins with facial erythema and eyelid involvement.The eyelids become swollen and violet pink in colour and may be tender to touch.Photosensitivity is a prominent feature.The nail folds may show enlarged capillary loops and the cuticles will appear ragged and frayed.Muscle weakness is seen early in severe cases and most frequently involves the shoulder or pelvic girdle muscles.Usually the skin features precede the muscle signs by a few months but some patients may never show muscle signs although muscle enzymes may be raised.The proportion of patients with dermatomyositis who have an associated malignancy is controversial but may be as high as 20%.