A 51-year-old, previously healthy white man presented with a 1-year history of tightening of the skin about his hands, fingers, upper trunk area, and perioral region, first noted following an influenzalike illness. The skin tightening progressed to involve his ears, neck, back, arms, and thighs, and he began noting decreased grip strength and hand coordination as well as difficulty in swallowing. A review of the systems demonstrated dysphagia and weight loss. There was no history of tryptophan use or significant industrial chemical exposure.
Mancini AJ, Kim YH. Skin Induration With Multiple Flesh-Colored Papules. Arch Dermatol. 1998;134(1):97-102. doi:10.1001/archderm.134.1.97