Abstract
Cutaneous changes often indicate the presence of undiagnosed systemic disease. Necrobiosis lipoidica may be the first manifestation of the diabetic state. Lupus erythematosus is characterized by a distinctive distribution of erythema and by scale and atrophic scarring. Hidebound alterations and thick plaques in the skin are distinctive of scleroderma. Heliotrope discoloration of the skin is unique to dermatomyositis.