This report describes the case of a 33-year-old black woman who presented atypical hyperkeratosis. Atypical features included location on the dorsum of the foot and presence of punctate pits. The lesion was classified as intermediate between keratosis punctata of the palmar creases and focal acral hyperkeratosis. The main elements of differential diagnosis are Hyperkeratosis lenticularis perstans and punctuated porokeratosis. The clinical and histological features of these lesions are discussed based on a review of the literature. Therapy including application of topical emollients is problematic.