Palmoplantar keratodermas (PPKs) are characterized by a thickening of the skin on the palms and soles of the feet caused by excessive keratin. Four forms can be seen, including diffuse, focal, punctate, and palmoplantar ectodermal dysplasias. Idiopathic, acquired PPKs should be reserved as a diagnosis of exclusion, when all the other etiologies have been investigated and ruled out. Herein, we report four cases of acquired punctate palmoplantar keratoderma with literature reviews. (Korean J Dermatol 2018;56(2):126∼129)