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Feb 2012

Cerebriform Hand Dermatitis and Facial Papules —Quiz Case

Arch Dermatol. 2012;148(2):247-252. doi:10.1001/archderm.148.2.247-d

A 63-year-old African American man presented with a 1-year history of progressive swelling, thickening, and fissuring of his hands associated with intermittent pain and sensitivity to cold. He also noted small papules developing on his nose, eyelids, and lips. The papules made eating uncomfortable but were otherwise asymptomatic. His medical history was notable for the excision of a laryngeal nodule 1 year before presentation.

On physical examination, small, waxy, flesh-colored, purpuric papules were noted at the nostrils, columella, and upper eyelids (Figure 1). Waxy, flesh-colored, confluent papules were evident on the vermilion lips. The volar surface of the fingers had skin-colored, soft plaques with cerebriform folds and mild fissuring (Figure 2). Laboratory evaluation revealed increased urinary total protein levels and free λ light chains and mildly decreased serum IgM and IgG levels. A 4-mm punch biopsy specimen was obtained from the left hand (Figure 3).