1. Demonstrate an ability to recognise skin signs of common or important systemic diseases including: granuloma annulare, dermatitis herpetiformis, necrobiosis lipodica, acanthosis nigricans, splinter haemorrhage, dermatomyositis, systemic lupus erythematosus, erythema nodosum, erythema multiforme, pruritisEdit

Granuloma annulareEdit

Granuloma Annulare-107

Photo from

A ring of waxy, erythematous papules. 

Associated diseases: diabetes, HIV infection.

Dermatitis herpetiformisEdit

Dermatitis herpetiformis

photo from

An itchy, blistering, persistent skin eruption.

Disease associations: Coeliac's 

Necrobiosis lipodica



Patches of redness on the shins. If larger, they will have a well-defined border, and a shiny yellowy centre, usually with visible blood vessels. 

Disease associatons: Insulin dependent and Non-Insulin dependent diabetes mellitus

Acanthosis NigricansEdit

Acanthosis nigricans


Hyperpigmentation and thick, velvety skin, especially in the skinfolds.

Disease associations: obesity, type 2 diabetes mellitus

Splinter HaemorrhageEdit



Thin, reddish-brown lines of blood running vertically under the nails

Disease associations: infective endocarditis



Copyright University of Iowa

Rash which appears on the face, knuckles, neck, shoulders, upper chest and back.

Systemic Lupus Erythematosus (SLE)Edit

As well as the classic 'butterfly' malar rash, skin manifestations of SLE include:

  • Vasculitic lesions around the nail folds
  • Purpura
  • Urticaria
  • Photosensitivity
  • Palma and plantar rashes
  • Pigmentation
  • Alopecia
  • Reynaud's phenomenon
  • Livedo reticularis (see picture below)
Livedo reticularis


Erythema NodosumEdit

Erythema nodosum

Picture from

Flat, firm, hot, red, painful lumps approximately an inch in diameter. They progress to purple, then brown colour.

Disease Associations: Streptococcus infection, bacterial gastroenteritides, pregnancy, antibiotic sensitivity reaction, leukaemia, lymphoma, sarcoidosis, rheumatic fever, Behcet's disease, ulcerative colitis, tuberculosis, leprosy, fungal infection, Chlamydia

Erythema MultiformeEdit

Literally meaning "Redness of many shapes"

Erythema multiforme


Disease associations: Herpes Simplex Virus (HSV), other viral infections, mycoplasma infection, connective tissue disease, HIV infection, Wegener's granulomatosis, carcinoma, lymphoma.



In the absence of rash, pruritis has the following disease associations:

  • Iron Deficiency Anaemia
  • Internal malignancy (especially lymphoma)
  • Diabetes mellitus
  • Chronic Kidney Disease
  • Chronic liver disease (especially primary biliary cirrhosis)
  • Thyroid disease
  • HIV infection
  • Polycythaemia vera
  • Herbal Supplement Review
Community content is available under CC-BY-SA unless otherwise noted.