Dear Editor,

A 72‐year‐old woman presented with a 3‐year history of numerous asymptomatic pinpoint keratotic lesions localised to bilateral palms with infrequent lesions to bilateral plantar feet. The patient reported no other dermatological history and family history of similar lesions and denied prior arsenic exposure. Her past medical history was significant for type 2 diabetes mellitus, chronic kidney disease stage 3B secondary to diabetic nephropathy, hypertension, dyslipidaemia and hypothyroidism.