Clue to Diagnosis: Flagellate Erythema in Anti-MDA5 Antibody-Positive Dermatomyositis in a Patient with Skin of Color

Anti–melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM) is a rare subtype of clinically amyopathic DM characterized by minimal muscle involvement, variable skin manifestations, and a high risk of rapidly progressive interstitial lung disease (RP-ILD). Atypical skin findings are frequently misdiagnosed, delaying recognition and treatment. We present the case of a 46-year-old Black woman who developed flagellate erythema, facilitating diagnosis of anti-MDA5 DM complicated by RP-ILD. This case highlights the importance of recognizing uncommon skin findings like flagellate erythema, especially in patients with subtle or atypical presentations, and emphasizes the importance of early diagnosis and prompt immunosuppressive therapy to improve clinical outcomes.