Shan, a 46-year-old chef, presents with multiple papules on the face, which have been present for several years and are gradually multiplying.

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<p>Shan, a 46-year-old chef, presents with multiple papules on the face, which have been present for several years and are gradually multiplying.</p><p>More recently she has noticed her face and smile feel ‘tight’. She has also noticed that her fingers are stiff, which is a problem at work.</p><p>There is no associated Raynaud’s phenomenon or dysphagia.</p><p>On examination, there are numerous 1-3mm waxy, skin-coloured papules on the face, neck, hands, forearms, trunk and thighs. There is also reduced joint mobility in the hands.</p><p>Pathology reveals normal FBC, EUC, LFT, autoimmune and inflammatory markers and thyroid function tests.</p><p>Protein electrophoresis shows an immunoglobulin G lambda monoclonal gammopathy and skin biopsy shows fibroblast proliferation with increased mucin and collagen deposition.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.