Heliotrope Rash: What Is It, And Why Call It That?

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by Marcin Gornsiewicz, M.D.


Heliotrope is a plant that produces clusters of sweet scented flowers in summer and has a very brilliant violet or purple color. It is considered poisonous, as it contains alkaloids, potent liver toxins, and will cause gastric distress in humans and animals if ingested. There are reported cases of death among horses, cattle and dogs. There have been no human losses to date, as this would be an unusual part of our diet. 

There is an autoimmune disease called Juvenile Dermatomyositis (JDM) that quite often manifests with red purplish, violet rash appearing on the eyelids and cheeks and referred to as a heliotrope rash due to the similarity between the rash’s color and the plant’s. This relatively rare but serious disease affects young children, usually diagnosed between the ages of 4 and 10. For some reason most of new cases occur in the spring and summer, and more often among girls than boys.

The immune system is a group of cells with special mission. It keeps people healthy and prevents infections. In JDM, like any other autoimmune diseases, the cells are triggered by certain factors (possibly viruses or environmental hazards), activated and unable to stop, harming the body instead of protecting it. In this particular disease, the immune system mistakenly targets blood vessels that lie primarily under the skin and in the muscles, which leads to inflammation. This is not a contagious disease, and there is nothing you could do to prevent it.

The two most characteristic findings in JDM are muscle weakness and skin rash. The muscles that are affected the most are near the trunk of the body (proximal muscles): the upper arms, the thighs, and the neck. Climbing stairs, getting up from the floor or chair, brushing hair, getting into the car may become difficult or even impossible. Muscles can be sore, but most children have little if any pain. In some cases the muscles used for swallowing can also be affected causing choking and voice changes. The red, purplish skin rash appears on the eyelids and face as the already mentioned heliotrope rash. Red, dry skin patches may also occur over the knuckles, elbows and knees and can be misdiagnosed as allergy or eczema. Ther rash gets worse in sunlight and may appear before, after or at the same time as the muscle weakness. Less characteristic but often associated symptoms include fatigue, irritability, joint pain and swelling, fever, and weight loss

The disease presents differently among children ranging from barely noticeable symptoms to severe multi-system involvement with complications including skin and stomach ulcers, lung problems, calcium deposition under the skin, contractures (shortened muscle that causes a joint to remain in a bent position).

JDM is a treatable disease but requires immunosuppressive therapy. Treatment is personally suited for each child. Most children go into remission within two years, and some or even all medications can be discontinued. However, more severe cases will require long-term treatment including drugs and physical therapy. It is important for children to be in good general health with emphasis on diet, exercise and skin protection from ultraviolet light.

Dr. Marcin Gornisiewicz graduated with an MD degree from the Medical School of Warsaw in Warsaw, Poland. He completed residency training in internal medicine at Saint Barnabas Medical Center in Livingston, New Jersey. He completed fellowship training in rheumatology at the University of Alabama at Birmingham in Birmingham, Alabama. He joined Rheumatology Consultants, PLLC (rheumatologyconsultants.org) in 2002. He is board certified in Rheumatology.

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