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The periphery gradually changes to become cyanotic or violaceous and forms a typical concentric, target lesion Mucosal involvement may occur Refer to the chapter Erythema multiforme Gianotti-Crosti syndrome (figures 47-48) Is a self-limited childhood exanthem that manifests in a characteristic acral distribution, and is rarely associated with systemic findings The rash is distributed symmetrically and acrally over the extensor surfaces of the extremities, the buttocks, and the face Lesions arise as monomorphous pale, pink-red or skin-coloured papules or papulovesicles , up to 1 cm in size Refer to the chapter on Gianotti-Crosti syndrome Lower legs (predominantly) Bullosis diabeticorum (figure 49) A distinct, spontaneous, non-inflammatory, bullous condition of acral skin that is unique to patients with diabetes mellitus Although bullae typically occur on the feet or lower legs, they also may occur on fingers, toes, hands, and arms Non-tender bullae, up to 2 cm in diameter, arise abruptly on non-erythematous skin Lesions heal spontaneously within 2-6 weeks Bullous pemphigoid - localised form (figure 50) Refer to the related chapter Bullous pemphigoid D ominant dystrophic epidermolysis bullosa - pretibial variant (figure 51) This condition, as the name implies, almost exclusively involves the anterior lower legs Individual lesions, which tend to be papular or plaque-like, are often somewhat violaceous, suggesting the clinical diagnosis of lichen planus

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