Öz seen on the pretibial surfaces, a clinical picture highly different from ACM 4 . The clinical features of nodu- lar amyloidosis with waxy, smooth papules, nodules or plaques on the face, trunk, or genitalia are also characteristic enough to distinguish it from ACM 2 . Acral persistent papular mucinosis may be confused with ACM, because of the presence of multiple, skin coloured papules localized to the hands and wrists. Alcian blue staining is a definite marker for its diag- nosis 5 . Disorders of porphyrin metabolism may be considered in the differential diagnosis of ACM, due to the involvement of sun-exposed areas 1 . However, in our patient lack of true blisters, milia, scarring, and the negative urine test in addition to positive staining with Congo red and amyloid P eliminated porphyria