English: Dermatomyositis, Heliotrope. In patients who have darker skin types (type III - VI skin), heliotrope can be subtle and perceived as inactive or normal, resulting in under-diagnosis in this presenting sign of dermatomyositis. A hallmark (i.e., pathognomonic) sign of dermatomyositis, consisting of violaceous to erythematous discrete or confluent macules confined to the upper eyelids. An eruption with similar characteristics can extend periorbitally. Heliotrope is often associated with periorbital edema and telangiectasias of the upper eyelids. In the resolution stage, atrophy or dyspigmentation (hypo- or hyperpigmentation) may be apparent.