<h3>To the Editor.—</h3> At the 1985 meeting of the Belgian Dermatological Society in Ghent, Belgium, we presented the case of a 66-year-old woman with a chronic, almost asymptomatic papular eruption on the extensor side of the distal third of the forearms and on the dorsa of the hands. Histologicexamination of a papule disclosed mucin in the reticular dermis. No evidence was found for paraproteinemia or thyroid disease. Our diagnosis was papular mucinosis (synonym, lichen myxedematosus).<sup>1</sup> In 1986, two articles were published in which the patients were described as having exactly the same clinical features as our patient; the authors argued that all three patients had the same disease and they introduced the diagnosis<i>acral persistent papular mucinosis</i>(APPM).<sup>2</sup> Five other cases have been published since (reviewed in references 3 and 4). We present our second case of this apparently not so uncommon entity, and discuss its relationship with lichen