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Dermatomyositis.—R. Y. a woman, aged 41, had urticaria, edema, erythema, and Raynaud's phenomenon of the hands at the age of 32. At age 35 examination here showed generalized erythema and thick keratinization of soles. A biopsy confirmed the clinical impression of pityriasis rubra pilaris. The same diagnosis had been made elsewhere. An x-ray of the chest showed diffuse miliary infiltrations. Multiple guinea-pig inoculations gave negative results.
During the next year and a half atrophy of the shoulder muscles with generalized erythema and desquamation developed. Muscle biopsy revealed dermatomyositis. Skin biopsy revealed "atypical lichen planus." X-ray of the hands showed acrosclerosis, with calcinosis in the fingers. An esophageal x-ray showed a negative picture. Analysis of 24-hour urine specimens revealed preformed creatinine, 340 mg., and creatine, 167 mg.
Six months later (March, 1949) she exhibited marked skin changes of the poikiloderma type. At this time her preformed creatinine was 583