A 10-year-old boy was referred to the dermatology department with a 1-year history of what appeared to be extensive warts on both

hands. On physical examination, multiple hyperkeratotic, erythematous, flat papules with central atrophy were present on the dorsum of the metacarpophalangeal and interphalangeal oints !"anel A#. A skin-biopsy specimen showed acanthosis, hyperkeratosis with focal vacuolar alteration of the basal-cell layer, and perivascular inflammatory infiltrates, findings that were consistent with $ottron%s papules. &he patient also had discrete facial heliotrope erythema !"anel '#. (e reported having no history of weakness, and the muscle-strength examination was normal. )aboratory evaluation revealed an elevated level of creatine kinase !*+0 , per liter- normal value, .1+0 , per liter#. &he results of proximal muscle electromyography and magnetic resonance imaging were normal. &he diagnostic skin findings in the absence of functional myopathy are characteristic of clinically amyopathic dermatomyositis. /ubclinical myositis does not seem to predict subse0uent, clinically evident myositis. &reatment with prednisolone was started, although the need for systemic treatment in patients with clinically amyopathic dermatomyositis is controversial. At 1 years of followup, the patient continued to have $ottron%s papules, but the heliotrope rash had resolved. (e had no musculoskeletal abnormalities, and his muscle en2ymes had returned to normal levels.