Juvenile dermatomyositis. Patients with JDM most often present initially with rash followed by muscle weakness. Characteristic rashes of JDM include the heliotrope rash (Fig. 202-1) and Gottron papules.The heliotrope rash is a faint lilac to erythematous discoloration over the eyelids that may be accompanied by periorbital edema. This child also has a malar rash.