Which statement best defines the shawl sign in dermatomyositis?

Which statement best defines the shawl sign in dermatomyositis?

• A. Rash over the shoulders and back of the neck
• B. Rash around the mouth
• C. Rash on the hands
• D. Vesicular lesions on extensor surfaces

Answer: (A)

In dermatomyositis, the shawl sign describes a photosensitive rash that drapes over the shoulders and the back of the neck, giving a shawl-like appearance across the upper back and posterior neck. This distribution is the hallmark of the sign, reflecting the way sun-exposed skin is preferentially affected in this condition. The other options point to different cutaneous features: a rash around the mouth isn’t the shawl pattern and isn’t the defining distribution; a rash on the hands refers to Gottron papules on the knuckles; vesicular lesions on extensor surfaces can occur in dermatologic conditions but do not define the shawl distribution.

In dermatomyositis, the shawl sign describes a photosensitive rash that drapes over the shoulders and the back of the neck, giving a shawl-like appearance across the upper back and posterior neck. This distribution is the hallmark of the sign, reflecting the way sun-exposed skin is preferentially affected in this condition. The other options point to different cutaneous features: a rash around the mouth isn’t the shawl pattern and isn’t the defining distribution; a rash on the hands refers to Gottron papules on the knuckles; vesicular lesions on extensor surfaces can occur in dermatologic conditions but do not define the shawl distribution.