Heliotrope Rash

A heliotrope rash is a dark or red to purple rash on or around your eyelids. It’s one of the most common signs of dermatomyositis. This is a rare but serious condition that causes inflammation in your skin and muscles.

The rash gets its name from the heliotrope (pronounced “HEE-lee-uh-trohp”) flower. It has a purple color similar to the skin changes seen in this condition.

If you notice new changes in your skin or muscles, it’s important to see a healthcare provider.

What does a heliotrope rash look like?

A heliotrope rash has the following features:

• Bumpy, rough, smooth or shiny
• Raised or swollen
• Red to purple or darker than your natural skin tone

It usually targets both eyelids. It may affect just the top, but it can affect your top and bottom eyelids at the same time. If you’re Black, the only sign of this rash could be swelling around your eyes.

What does a heliotrope rash feel like?

A heliotrope rash may feel:

• Dry
• Itchy
• Painful (burning)

A rash near your eyes can make it hard to see clearly. This is especially true if your eyelids swell.

Does a heliotrope rash come and go?

Yes. This type of rash often flares up and then fades instead of staying on your skin all the time. How often it appears depends on the course of dermatomyositis. Treatment can help reduce how often flare-ups happen and make them less severe.

Heliotrope rash causes

A heliotrope rash happens because of inflammation in the small blood vessels and skin around your eyes. The most common cause is dermatomyositis. This is an inflammatory condition where your immune system mistakenly attacks healthy skin and muscle cells.

What’s a differential diagnosis for a heliotrope rash?

When diagnosing a heliotrope rash, your healthcare provider may consider other conditions that have similar symptoms. This is called a differential diagnosis.

Possible conditions that may resemble a heliotrope rash include:

• Eyelid dermatitis (contact or periorbital): It can cause discolored, scaly or itchy patches on your eyelids.
• Eczema (atopic dermatitis): This chronic skin condition can make your eyelids dry, itchy and inflamed.
• Lichen planus: An inflammatory skin condition that can cause discolored bumps or rashes.
• Lupus (systemic or cutaneous): It can cause a discolored rash on your face, especially across your cheeks and eyelids.
• Psoriasis: This causes thick, scaly, silvery patches of skin that can affect your face. In rare cases, it can affect your eyelids.
• Rosacea: This common skin condition leads to facial redness, especially on your cheeks and nose.

Your provider will use your medical history and physical exam to help make a diagnosis. They may also recommend blood tests or a skin biopsy, which is taking a sample of your skin. These tests help rule out other conditions to make an accurate diagnosis.

Heliotrope rash treatment

Treatment focuses on reducing inflammation and protecting your skin. Your healthcare provider may recommend:

• Corticosteroid medications: These may come as topical creams you apply directly to the rash. They also come as pills (like prednisone) you take with water.
• Immunosuppressant medications: Drugs like methotrexate, azathioprine, mycophenolate mofetil or hydroxychloroquine may reduce inflammation.
• Topical creams, lotions or ointments: These can soothe skin irritation and reduce discoloration.

Dermatomyositis also causes muscle weakness. If you have this symptom, too, your provider may recommend other treatments to manage this as well. You’ll likely need regular follow-up visits to adjust treatment and monitor your progress.

What can I do at home to treat a heliotrope rash?

Your healthcare provider will give you specific instructions for caring for your skin at home. Their advice may include:

• Avoid makeup that could irritate your skin. If you do wear makeup, remove it completely at the end of the day.
• Take over-the-counter antihistamines if your rash itches.
• Use gentle skin care products, like soaps and cleansers made for sensitive skin.

Because sunlight can make dermatomyositis symptoms worse, it’s important to protect your skin when outdoors. Use a broad-spectrum sunscreen (SPF 30 or higher), wear protective clothing and avoid prolonged sun exposure when possible.

When should a heliotrope rash be treated by a doctor or healthcare provider?

See a healthcare provider if you have a rash that’s painful, itchy or not going away. It’s especially important to tell your provider if you also have muscle pain or weakness. These can be signs of dermatomyositis.