Punctate keratosis of the palms and soles and keratotic pits of the palmar creases are frequently confused. A prospective study of 283 patients revealed a prevalence of 11% and 3%, respectively, in a metropolitan county hospital dermatology clinic. Punctate keratosis of the palms and soles and keratotic pits of the palmar creases are similar in size, number of lesions per palm, aggravation by trauma, and predominance in blacks and in men. These entities are different in appearance, distribution, age at onset, prevalence, symptoms, and prognosis. Punctate keratosis of the palms and soles and keratotic pits of the palmar creases should be considered independent entities. To help eliminate confusion, we propose that punctate keratoses refer only to the hyperkeratotic papules scattered diffusely in the palms and occasionally in the soles and that keratotic pits of the palmar creases refer only the hyperkeratotic, conical depressions confined to the palmar creases.