Increased IL-23 is Associated to Heliotrope Sign in Multivariate Model on Idiopathic Inflammatory Myopathies.
- 1Instituto de Investigación en Reumatología y del Sistema Músculo-Esquelético (IIRSME) Departamento de Biología Molecular y Genómica Centro Universitario de Ciencias de la Salud Universidad de Guadalajara Guadalajara Jalisco Mexico udg.mx.
- 2Departamento de Fisiología Centro Universitario de Ciencias de la Salud Universidad de Guadalajara Guadalajara Jalisco Mexico udg.mx.
- 3División de Medicina Interna Servicio de Reumatología SNP 004086-SECIHTI Nuevo Hospital Civil "Dr. Juan I. Menchaca" Guadalajara Jalisco Mexico.
Abstract
Heliotrope rash is a pathognomonic feature of dermatomyositis (DM); however, the molecular pathways implicated in cutaneous involvement have not been fully explored. Although the IL-23/Th17 axis has been implicated in inflammatory and autoimmune diseases, the clinical significance of circulating IL-23 across the idiopathic inflammatory myopathy (IIM) spectrum, particularly in cutaneous disease expression, remains insufficiently defined. In this cross-sectional study, we aimed to quantify serum IL-23 levels in patients with IIM and evaluate their association with cutaneous involvement, including overall skin disease activity assessed by the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) and the presence of specific skin manifestations, particularly pathognomonic lesions, using a univariate analysis. Serum IL-23 levels were measured by Enzyme-Linked Immunosorbent Assay (ELISA) in patients with IIM and healthy controls (HCs), and their relationships with clinical and cutaneous variables were analyzed using univariable and multivariable approaches. Higher IL-23 levels were associated with cutaneous involvement, especially with pathognomonic skin manifestations and, most notably, heliotrope sign. IL-23 also showed a positive correlation with CDASI activity; the relationship with heliotrope sign remained consistent. Applying a multivariate model, heliotrope rash remained the only independent factor associated with IL-23 levels: in other words, IL-23 increases by 437.3 pg/mL when heliotrope is present. These findings suggest that IL-23 may be preferentially associated with a cutaneous phenotype characterized by heliotrope rash, rather than with global skin burden alone.
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BibTeX
@article{juarezgomez2026increased,
title = {{Increased IL-23 is Associated to Heliotrope Sign in Multivariate Model on Idiopathic Inflammatory Myopathies.}},
author = {Christian Juarez-Gomez and Oscar Pizano-Martinez and María Guadalupe Ramírez-Dueñas and Cynthia-Alejandra Gomez-Rios and Maribell Cabrera-López and Arcelia Llamas-García and Andrea Aguilar-Vazquez and Monica Vazquez-Del-Mercado},
journal = {Dermatology research and practice},
year = {2026},
month = oct,
doi = {10.1155/drp/4660804},
url = {https://europepmc.org/article/MED/42910166},
note = {CC BY},
}
RIS
TY - JOUR
TI - Increased IL-23 is Associated to Heliotrope Sign in Multivariate Model on Idiopathic Inflammatory Myopathies.
AU - Christian Juarez-Gomez
AU - Oscar Pizano-Martinez
AU - María Guadalupe Ramírez-Dueñas
AU - Cynthia-Alejandra Gomez-Rios
AU - Maribell Cabrera-López
AU - Arcelia Llamas-García
AU - Andrea Aguilar-Vazquez
AU - Monica Vazquez-Del-Mercado
PY - 2026
DA - 2026/10/21
JO - Dermatology research and practice
DO - 10.1155/drp/4660804
UR - https://europepmc.org/article/MED/42910166
AB - Heliotrope rash is a pathognomonic feature of dermatomyositis (DM); however, the molecular pathways implicated in cutaneous involvement have not been fully explored. Although the IL-23/Th17 axis has been implicated in inflammatory and autoimmune diseases, the clinical significance of circulating IL-23 across the idiopathic inflammatory myopathy (IIM) spectrum, particularly in cutaneous disease expression, remains insufficiently defined. In this cross-sectional study, we aimed to quantify serum IL-23 levels in patients with IIM and evaluate their association with cutaneous involvement, including overall skin disease activity assessed by the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) and the presence of specific skin manifestations, particularly pathognomonic lesions, using a univariate analysis. Serum IL-23 levels were measured by Enzyme-Linked Immunosorbent Assay (ELISA) in patients with IIM and healthy controls (HCs), and their relationships with clinical and cutaneous variables were analyzed using univariable and multivariable approaches. Higher IL-23 levels were associated with cutaneous involvement, especially with pathognomonic skin manifestations and, most notably, heliotrope sign. IL-23 also showed a positive correlation with CDASI activity; the relationship with heliotrope sign remained consistent. Applying a multivariate model, heliotrope rash remained the only independent factor associated with IL-23 levels: in other words, IL-23 increases by 437.3 pg/mL when heliotrope is present. These findings suggest that IL-23 may be preferentially associated with a cutaneous phenotype characterized by heliotrope rash, rather than with global skin burden alone.
SN - 1687-6105
SN - 1687-6113
ER -