INSTRUCTION
Examine this patient's legs.Examine this patient's abdomen.

SALIENT FEATURES
History

Ask the patient whether she exposed the affected area to heat.

Examination

Reticular erythematous or pigmented rash, usually on the forelegs (or abdomen), knownas 'Granny's tartan'.

Proceed as follows:

Look for features of hypothyroidism (pulse, ankle jerks).

Tell the examiner that you would like to proceed as follows:- Measure T4 and thyroid-stimulating hormone (TSH) levels.- Investigate for chronic pancreatitis and intra-abdominal malignancy.

Note. If the rash is present over the anterior abdominal wall or lumbar region, it is verylikely that there is an intra-abdominal malignancy or chronic pancreatitis (Lancet 1997;350: 1379-85; J R Soc Med 1984; 77: 299-31).

Quastions

Mention some skin abnormalities related to heat or cold.

• Erythema ab igne.

• Livedo reticularis (due to cold in young women).

• Raynaud's phenomenon.

• Chilblains.