A 22-year-old Bangladeshian man presented with slightly painful, multiple, craterlike depressions confined to the palmar creases of the digits and palms. The first lesions, which were punctiform hyperkeratotic plugs, were noticed 4 years before. Occasionally, some lesions became painful, thicker and then were removed spontaneously, leaving tiny pits, where a new plug developed again a few days later. He was a manual worker with neither history of arsenic exposure nor syphilis. No lesion was detected on the soles. There was no familial history of similar palmar lesions.On cutaneous examination, numerous, tiny, hyperkeratotic, skin colored pits were found on the palmar creases of both hands, with a predilection for the transpalmar crease and the proximal interphalangeal joint crease of the left hand (Fig. 1). He was generally in good condition and had no other skin lesion.Histologic examination of the serial section of a hyperkeratotic pit revealed cup-shaped epidermal central depression with marked parakeratotic hyperkeratosis and acanthosis. Mild perivascular lymphohistiocytic cell infiltration was seen in the upper dermis. Focal vacuolated cells were shown in the epidermis, but vertical tiers of parakeratotic cells, clumped keratohyaline grunules and hypergranulosis were not shown (Fig. 2).He was treated with only topical emollients, resulting in moderate improvement. DISCUSSIONKeratosis punctata of the palmar creases (KPPC) was first described by Arnold 2 in 1947, in a white male, as a variant of Kyrle's disease. The condition is defined as the presence of punctiform hyperkeratotic plugs, with a raised horn, 1-4mm in diameter Keratosis punctata of the palmar creases (KPPC) is a rare skin condition characterized by punctiform hyperkeratotic pits confined to the palmar and digital creases. Although this condition has been regarded as a variant of classical punctate keratoses, there are some differences between classical punctate keratosis and KPPC. We herein report a case of KPPC in a 22-year-old man who had numerous, tiny, hyperkeratotic pits limited to the palmar creases of both hands with typical histologic findings.

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