Abstract Acral persistent papular mucinosis (APPM) is a rare subtype of localized lichen myxedematosus. It consists of small papules localized exclusively on the back of the hands. wrists and extensor aspects of distal forearms with no other clinical or laboratory manifestations. The lesions tend to persist and may increase slowly in number. https://www.nacrack.com/quick-save-TRAILMASTER-CHALLENGER-200X-UTV-2-SEATER-super-grab/