Palmoplantar keratodermas (PPKs), also known as 'keratosis palmaris et plantaris', are a heterogeneous group of disorders characterized by abnormal thickening of the epidermal skin of the palms and soles leading to hyperkeratosis. It could be acquired or hereditary. Acquired PPK often occurs as a paraneoplastic syndrome as well as a stigma of other dermatoses. We report a rare case of paraneoplastic PPK secondary to mixed neuroendocrine tumor of the pancreas with complete remission after surgical excision of the cancer.

Olmsted syndrome is a rare genetic disorder characterized by severe thickening of the palms and soles, often resistant to conventional treatments. We present the case of a patient with Olmsted syndrome with a 16-year follow-up. The patient presented at five years of age with treatment-resistant palmoplantar keratoderma despite three years of dermatological management, leading to complications. Surgical interventions included initial debridement down to the deep dermis, which resulted in recurrence after three months. This was followed by a decision for extensive excision down to the subcutaneous tissue, use of a bilayer wound matrix dressing followed by negative pressure wound therapy, and a thin split-thickness graft, resulting in full resolution. The patient, now a college student, has regained normal daily activities. This case underscores the challenges and highlights a novel surgical approach for managing Olmsted syndrome, demonstrating a 16-year follow-up and aiming to improve patient outcomes in these complex cases.