An 84-year-old African American woman presented with a 1-year history of "bumps" that started on her wrists, then spread to her arms and hands, and eventually also involved her right ear. The lesions were occasionally pruritic and tender. Her medical history was significant for hypertension, transient ischemic attack, peptic ulcer disease, and anxiety. She had no history of thyroid disorder.
Her physical examination revealed multiple lichenoid papules, some coalescing into plaques located on the dorsal aspect of her hands (Figure 1), arms (Figure 2), and right ear (Figure 3). Laboratory analysis revealed that her serum protein level was elevated (97 g/L). Serum protein electrophoresis demonstrated an elevated γ-globulin concentration (14.7 g/L [reference value, <14.0 g/L]), and a homogeneous band was present in the IgG zone. Immunoelectrophoresis identified an IgG λ paraprotein. A complete blood cell count was normal. Thyroid function test results were normal.
Horton S, Hashimoto K. Lichenoid Papules on the Hands, Arms, and Ear of an 84-Year-Old Woman. Arch Dermatol. 2001;137(2):219-224. doi: