Derm Dx: Itchy rash on eyelids, chest, back, and hands

A patient aged 40 years presents with complaints of a mildly itchy rash on his eyelids, chest, back, and hands for the past three months. He reported feeling weak over the past month and that the weakness was getting progressively worse. The patient admitted he found it difficult to stand up from sitting. He was previously healthy.

A physical exam reveals ...