Diagnostic criteria include (1) a generalized papular and sclerodermoid eruption, (2) histopathologic findings of mucin deposition, fibroblast proliferation, and fibrosis (microscopic triad), or an interstitial granulomatous pattern, (3) the presence of monoclonal gammopathy, and (4) the absence of thyroid dysfunction.1 Here, MUC5AC is linked to monoclonal gammopathy.