Editor Acrokeratoelastoidosis (AKE) is a genodermatosis characterized by small, firm papules or plaques on the sides of the hands and feet, 1 and it was first described in 1953 by Costa, in a Brazilian patient. It is a rare disease, and both autosomal dominant and sporadic forms have been observed. 2 It is characterized by multiple hyperkeratotic papules on the palms, soles and dorsum of the hands and feet. Typical histopathological findings in AKE include hyperkeratosis, acanthosis with fragmented and decreased elastic fibres in reticular dermis (elastorrhexis). 3 Electron microscopy (EM) findings in AKE are limited. A 45-year-old white woman presented with small asymptomatic palmar papules that emerged at the beginning of adolescence. These papules were waxy and in great number along the borders of the hands, but were also present in the flexures of the fingers (Fig. 1a). In detail, the dermatoglyphics were not affected (Fig. 1b), suggesting a dermal involvement. The patient had a bureaucratic job and her activities and hobbies did not require constant use of hands. The feet were not affected. She denied a positive family history. Light microscopy with HE staining showed unspecific findings with compact hyperkeratosis and marked acanthosis.