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, which diseases cause edematous purplish spots on both upper eyelids of patients? The following is a brief description: 1. Gonococcal haemorrhage Gonococcal haemorrhage is a chronic sexually transmitted disease characterized by scattered ruptured red papules, and canal fistulas and bruises may also occur. These papules mostly involve the ends of the extremities and develop rapidly into macules, pustules, most commonly bleeding, and can also form large blisters. The papules are elevated at maturity, ulcerated in the center, gray in color, and surrounded by erythema, which heals in 3 to 4 days and may be accompanied by fever and joint pain. 2. Granuloma annulare Granuloma annulare is a chronic benign papule that fuses to form a dermatome. The papule rapidly expands around to form a ring with a mildly sunken center, which is common on the feet, lower extremities, hands and fingers. 3, Human immunodeficiency virus (HIV) infection HIV acute infection can cause maculopapular rash, other manifestations include fever, general malaise, sore throat, headache, lymph node enlargement, hepatosplenomegaly. Most patients cannot recall these symptoms of acute infection. 4. Insect bites Insect bites (e.g., lice, flies, mosquitoes) can cause an allergic reaction with papules, macules, or petechiae when the insect’s salivary secretions are present. It is accompanied by non-specific symptoms and signs. Such as fever, myalgia, headache, enlarged lymph nodes, nausea, vomiting.