A 55-year-old man was referred to the dermatology department for a long history of asymptomatic lesions on the skin of his neck and axillae. He had a remarkable history of recurrent ischemic strokes and cerebral small vessel disease with progressive cognitive decline during the last 10 years. He was also a regular smoker and he suffered from diabetes mellitus, hyperlipidemia, obesity, hypertension and hypertensive heart disease. Physical examination revealed small, yellowish papules looking like “goosebumps” in the lateral aspects of the neck (Fig. 1A) and a thickened and hanging skin in both axillae (Fig. 1B).