Multiple minute digitate hyperkeratoses associated with paraproteinaemia.

An 87 year old woman with dementia presented with multiple digitate hyperkeratoses on her face, limbs and chest. She had a previous diagnosis of a paraproteinaemia, with a serum monoclonal band of immunoglobulin G-kappa and anaemia being detected. The skin biopsy of these hyperkeratotic lesions was characterized by multiple areas of orthokeratosis with immunoglobulin deposition. There was no association with hair follicles. These multiple digitate hyperkeratoses have been associated with underlying systemic disorders including malignancies.