Condition	Clinical course	Skin changes
Dermatomyositis	Proximal muscle weakness causing difficulty climbing stairs, rising from a seat, or combing hair; skin changes may precede, follow, or present simultaneously with muscle involvement	A pathognomonic heliotrope erythema around the eyelids; Gottron papules on the knuckles and sides of the fingers, and dusky-red to violet skin changes over sun-exposed areas; periungual erythema and telangiectasis may develop
Rheumatoid arthritis	Chronic symmetrical polyarthritis beginning with fatigue, weakness, morning stiffness, synovial thickening, and vague musculoskeletal symptoms; rheumatoid nodules may occur; rheumatoid vasculitis can affect nearly any organ system	Cutaneous vasculitis may present as crops of small brown spots in the nail beds, nail folds, and digital pulp; larger ischemic ulcers may develop, often in the lower extremity
Scleroderma	Systemic condition often affecting the upper extremities, initially with edema, later with skin thickening and fibrosis	“Salt-and-pepper” skin may occur in some patients with dark skin; taut, shiny skin with slow-healing ulcerations develops later
Systemic lupus erythematosus	Nonpruritic, erythematous to violaceous plaques; telangiectasias, alopecia, urticaria, and Raynaud phenomenon are also common	Plaques on sun-exposed areas, with butterfly-shaped facial distribution; erythema and telangiectasis tend to spare the knuckles
Vitiligo with repigmentation	Progressive disease caused by autoimmune destruction of melanocytes; loss of pigmentation may be localized or generalized	Tends to occur on the face, hands, in body folds, and around body openings (e.g., eyes, nose, mouth); repigmentation begins around hair follicles