Microscopic examination revealed a thick keratin layer with an unremarkable epidermis and a thickened dermis. Hematoxylin-eosin staining revealed collagen bundles that were separated by amorphous, faintly bluish material. There were no inflammatory cells and no increase in the number of fibroblasts in the dermis. Alcian blue staining (Figure 3) revealed extensive deposits of mucin in the upper and lower dermis, consistent with localized myxedema.