A variety of rheumatic diseases—systemic lupus erythematosus
(SLE), rheumatoid arthritis (RA), and the vasculitides among
them—manifest as “lumps, bumps, and holes” involving the
extremities. Each of these diseases works through specific
mechanisms on different structures of the skin to produce a
distinctive pathology. In doing so, each provides clues to the
cause, which the history and physical examination can help
confirm. Here we present a concise photoessay of those cutaneous
manifestations that are commonly (but not solely) the presenting
signs of SLE and RA. Skin biopsy is sometimes necessary for a
definitive diagnosis; useful results depend on a technique that
gives the depth necessary to see the pathology and on referral
to an experienced dermatopathologist for the proper
interpretation of biopsy specimens. In a separate photoessay, we
focus on relatively common manifestations of vasculitis and
Behçet's disease that involve the legs. Systemic Lupus
Erythematosus An autoimmune rheumatic disease that ma