Multiple hyperkeratotic spicules and myeloma

We report the case of a 58-year-old patient with multiple myeloma with a monoclonal gammopathy of the IgG type, who developed a striking eruption characterized by multiple hyperkeratotic spicules of the face, nose and scalp. Light-microscopic studies revealed a follicular orthohyperkeratosis, while direct immunofluorescence microscopy remained negative. Hence, our patient presented features characteristic of a rare distinctive disorder associated with an underlying paraprotein or multiple myeloma, paraneoplastic hyperkeratotic spicules.