How to diagnose edematous purplish spots on both upper eyelids?

　　The typical lesion of dermatomyositis, an edematous purplish-red patch on both upper eyelids, spreads to the periorbital area and gradually expands to the V-zone of the face, neck and upper chest. A purplish papule on the extremities of the elbows and knees, especially on the extensor side of the metacarpophalangeal and interphalangeal joints, with dilated capillaries and hypopigmentation, covered with fine scales, is called Gottron’s (Gordon) sign or Grottron’s papule. It is associated with a variety of infections. So, how do you diagnose edematous purplish spots on both upper eyelids? The following is a brief description: 1. Muscular symptoms: usually involving the transverse muscle, sometimes smooth muscle and cardiac muscle can also be involved. Any part of the muscle can be invaded, but often the muscles of the extremities are the first to be involved, and the proximal muscles of the liver are more susceptible to damage than the distal ones. The muscles of the scapular and pelvic girdles are usually the first to be affected, followed by the upper arm and femoral muscles, and to a lesser extent the muscles of other areas. The 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 succession, one after the other; usually the patient feels weakness, followed by muscle pain, pressing pain and motor pain; and then various motor dysfunctions and specific postures due to decreased muscle strength. The symptoms may vary depending on the number, severity, and location of the muscle lesions, and usually include difficulty in raising the arms, head movement, or standing up after squatting, and poor gait. When the muscles of the pharynx, upper esophagus and palate are involved, hoarseness and dysphagia may occur; when the diaphragm and intercostal muscles are involved, shortness of breath and dyspnea may occur; when the heart muscle is involved, heart failure may occur; when the eye muscle is involved, diplopia may occur. The texture of the lesioned muscles may be as normal or as soft as Tension, sometimes it may become hard or solid after fibrous transformation, which may cause joint contracture and affect the function, and there are also reports of myasthenia gravis-like syndrome, i.e. painless muscle weakness, which intensifies after activity. The skin above the lesioned muscle may be thickened or edematous.　　2, skin symptoms: the disease has a variety of skin damage, some are the first symptoms; some have a certain specificity, which is helpful for diagnosis; some appear to suggest concomitant visceral malignancy; some are related to the prognosis. The lesions are often not parallel to the degree of muscle involvement, sometimes the lesions can be more extensive with only mild myositis, and conversely there are severe muscle lesions with only mild lesions, sometimes the lesions reflect the degree of muscle lesions. The lesions are usually purplish on the face, especially on the upper eyelids, and gradually expand diffusely to the forehead, cheek, preauricular, neck, and upper chest V-zones, as well as the scalp and postauricular region. Dendritic capillaries are clearly dilated near the lid margin of the closed eye, and occasionally capillaries with pinhead-sized petechiae at the tip of the bend are seen; the periorbital puffy purplish-red patches centered on the eyelid are characteristic. The appearance of purple-red papules and spots on the extensor surfaces of the elbows and knees, especially the metacarpophalangeal and interphalangeal joints, which later become atrophic, with capillary dilation, hypopigmentation and fine scales overlying, and occasionally ulceration, called Gottron’s sign, is also characteristic, and rigid capillary dilation and petechiae can be seen in the nail root crease, which helps in the diagnosis. In some cases, the rash may also appear on the trunk as diffuse or limited dark red spots or papules on the skin of the anterior sternum or between the scapular muscles or the lower back, usually without pruritus, pain, or sensory abnormalities, but in a few cases there may be severe itching, and the damage is transient, recurrent, and then fuses with each other and persists, covered with fine scales, and the oral mucosa also appears erythematous.