History: An adult man presented with thickening of the skin in folds, accentuation of creases on the face especially on the forehead (deepened horizontal lines) and clubbing of the fingers. The eyelids were markedly thickened and the hands were spade shaped. These changes were noticed since early childhood and the patient had no underlying cyanotic lung or heart disease. This case is an example of hereditary pachydermoperiostosis.