Extremities:  Examination of the hands reveals some tenderness at the base of her thumbs bilaterally as well as at the PIP joint and DIP joint.  Her armpits are examined.  She has what appears to be a tinea versicolor rash present in the armpits bilaterally.  She has a lesion on her left shoulder, which is 6 mm in diameter.  It has diffuse borders and is slightly red.  It has two brown spots in it.  In her lower extremities, there is no cyanosis or edema.  Pulses at the radial and posterior tibial pulses are normal bilaterally.  Her gait is normal.