Abstract
<h3>To the Editor.—</h3> Punctate keratoderma is a descriptive diagnosis indicating the presence of small point-like horny excresences disposed irregularly over the palms, soles, and flexor aspects of the digits. On biopsy, the excresence classically shows simple hyperkeratosis with underlying acanthosis; if parakeratosis is seen, it is minimal and incidental. This condition is usually associated with no other dermatologic abnormality and inheritance is determined by an autosomal dominant gene with variable penetrance within a family.<sup>1</sup>A case was recently seen at the San Diego Naval Hospital which filled the criteria both descriptively and genetically but differed in exhibiting an unusual histologic finding. <h3>Report of a Case</h3> The patient is a 20-year-old white Petty Officer who shortly after puberty noticed the development of small punctate keratotic projections arising on the palms and soles. These have increased in number over the years, spreading to involve the flexor aspects of the digits (Fig
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