A 60-year-old obese man was referred to our department from the internal medicine unit. He had a 20-year history of poorly controlled diabetes (no other cases in the family), and was admitted to hospital because of respiratory and consequent heart failure. Skin examination showed diffuse xerosis and a rough, sandpaper-like appearance of the skin of the finger, of approximately 15 years’duration, consisting of multiple, minute, hyperkeratotic papules grouped in a miniature “cobblestone”pattern on the dorsum of the distal phalanges (Fig. 1), more dense over the knuckles and the interphalangeal joints. No pruritus was present. He was a pensioner, who had been physically inactive for months previously, and this condition had occurred progressively in the absence of any known trauma. N o other cutaneous manifestations were evident. Histologic examination was perfor med using hematoxylin and eosin staining of a biopsy specimen taken from the lef t second finger; it displayed a hyperorthokeratotic epidermis with enlarged derm al papillae, thickened and vertically oriented collagen bundles, few elastic fib ers, and a mild perivascular inflammatory infiltrate. A 60-year-old obese man was referred to our department from the internal medicine unit. He had a 20-year history of poorly controlled diabetes (no other cases in the family), and was admitted to hospital because of respiratory and consequent heart failure. Skin examination showed diffuse xerosis and a rough, sandpaper-like appearance of the skin of the finger, of approximately 15 years’duration, consisting of multiple, minute, hyperkeratotic papules grouped in a miniature “cobblestone” pattern on the dorsum of the No pruritus was present. He was a pensioner, who had been physically inactive for months previously, and this condition occurred occurred inively in the absence of any known trauma . N o other cutaneous manifestations were evident. Histologic examination was performed med using hematoxylin and eosin staining of a biopsy specimen taken from the lef t second finger; it displayed a hyperortho keratotic epidermis with enlarged derm al papillae, thickened and vertically oriented collagen bundles, few elastic fib ers, and a mild perivascular inflammatory infiltrate.