A man in his 60s presented with a 2-year history of progressive skin tightening and the formation of multiple asymptomatic papules symmetrically distributed on the extremities, face, and neck. He also developed mild dysphagia, intermittent voice hoarseness, and difficulty closing his mouth, with drooling while eating. He reported a 9.1-kg weight loss owing to difficulty eating during the past year.
Physical examination revealed diffuse hardening of the skin with multiple 1- to 3-mm white to skin-colored papules on the dorsal aspect of the hands (Figure, A), arms, knees, posterior aspect of the neck, and posterior auricular area (Figure, B). There was decreased ability to pinch the skin on the forearms, and the oral aperture was slightly decreased at 3 cm. A 5-mm skin punch biopsy was performed on the right forearm for evaluation (Figure, C).
Applebaum DS, Daulat S, Duvic M. Multiple Skin-Colored Papules With Diffuse Sclerosis. JAMA Dermatol. 2014;150(8):893–894. doi:10.1001/jamadermatol.2014.14