Skin growths on a patient's hand. The small round growths (some at lower right) are thickened areas of the horny (keratinous) layer in the skin. This is Buschke-Fischer-Brauer keratoderma syndrome, a rare inherited condition. It develops on the palms of the hands and the soles of the feet, and is also known as punctate palmoplantar keratoderma. Punctate refers to the small rounded appearance of the growths. The growths are an overproduction of keratin, a major skin protein. They can be painful, especially if the callosities of the feet interfere with walking. Some drugs can be used to reduce the size of the growths.