Children and adolescents
Juvenile dermatomyositis (JDM)
Heliotrope rash, Gottron papules and proximal weakness in a child. Calcinosis is more common than in adults.
What to look for
- Heliotrope rash, Gottron papules, nailfold capillary changes
- Proximal weakness (Gowers sign), fatigue, dysphagia or voice change
- Raised CK, aldolase, AST or LDH. Muscle enzymes can be normal.
What to do
- Send CK, aldolase, AST/ALT, LDH, CBC, metabolic panel, ANA and a myositis antibody panel.
- MRI of the thighs if the diagnosis is uncertain.
- Dysphagia, breathing difficulty or skin ulceration is emergent.
- Malignancy is uncommon in children compared with adults.
About this urgency level
Early specialist assessment changes outcomes. Send the usual workup with the referral, but don't hold the referral while waiting for results.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.
Sources