History: A 60-year-old man presented with a one-year-history of fatigue, weight loss and a skin rash. On examination he had extensive periorbital ecchymosis, hemorrhagic papules and purpura in the neck flexure, waxy infiltrative papules involved both surfaces of the hands, some of which had pseudovesicular appearance and partial anonychia. On investigations, no plasma-cell dyscrasias has been found.