38-Year-Old Female with Intensely Itchy, Erythematous Scalp and Muscle Weakness

A 38-year-old female presented with itching and erythema of the scalp. She had been treated with antifungal shampoos and topical steroids with little improvement. She also reported a rash on the sun-exposed sites of her chest and back that would also itch. The rashes were treated with topical steroids and improved but would typically recur, especially after sun exposure. She reported difficulty with getting out of a chair and walking upstairs. She stated that her muscles just felt fatigued at times; she could not complete basic activities. In addition, she reported difficulty swallowing, joint pain, and fatigue.