Case presentation A 63-year-old woman presented with a 6-year history of discoloured areas on right palm, right middle and ring fingers. She was asymptomatic except for one episode of bleeding from the affected area following minor trauma. She was right handed. Past medical history included premature labour followed by total abdominal hysterectomy, irritable bowel syndrome, essential hypertension, duodenal ulcer, cerebrovascular accident and depression. She was an ex-smoker. Her current medication included aspirin. There was no drug allergy. Examination revealed dull red, flat, non-pulsatile areas on palm (Figs 1 and 2). There was no hyperkeratosis or ulceration. Small venous lake on right upper lip was noted.