An 80-year-old white woman had a 6-year history of enlarging, intradermal plaques on the distal, volar, and lateral surfaces of the fingers. A biopsy specimen showed whorled, densely aggregated bundles of coarsely thickened collagen within a sparsely cellular papillary and reticular dermis. The fibrosis entrapped eccrine sweat coils and focally extended into the subcutis. This case represents an unusual, predominantly acral form of acquired, progressive, cutaneous fibrosis, which we propose to call distal pachydermodactyly. (J Am Acad Dermatol 1998;38:359-62.)