“My skin is becoming stiff,” recounted a forty-three-year-old woman. For the past few months she had noted a woody firmness of the skin on her thighs and there were red patches on her shins which also felt stiff. Her face, hands, and feet were normal. She had always been in good health and blood studies showed only a mild increase in her eosinophilic white cells.

Clinically, we felt she had the hardened skin patches of morphea, the localized form of scleroderma. We attempted to ferret out a cause, with no luck. She was taking no medications. There had been no tick bites or even a leech bite, which had caused morphea in one of our patients. She denied infections or exposure to organic chemicals, such as polyvinyl chloride, known to harden the skin. She also did not take the drug, methysergide, notorious for its ability to indurate connective tissue. She had never had silicone breast implants, which might leak and induce sclerotic skin.

We tried both cortisone and antibiotic therapy without success, as well as topical emollients which were likewise without effect. We were still searching for a cause when the patient came in with the answer and with an apology. She had found the reason in the newspaper, learning that the FDA had banned the sale of the amino acid, tryptophan. This over-the-counter compound used by thousands to combat insomnia and depression was now linked to hundreds of cases of hardening of the skin.