A Woman with Leonine Facies and Monoclonal Gammopathy.

A 32-year-old woman presented to the dermatology clinic with a three-year history of progressive skin thickening. On examination, skin of glabella was thickened with longitudinal furrows, resulting in leonine facies. Skin-colored to reddish-brown, firm, waxy, closely spaced papules partially coalescing to form sheets of induration with circular punched out areas of sparing in between, over face, neck, trunk, abdomen, arms and thighs. She additionally complaint of tingling sensation and occasional pain over lateral side of hands. Punch biopsy obtained from a papule over the nape of neck revealed fibroblast proliferation with collagen and mucin deposition in upper and mid-reticular dermis.