Palmoplantar keratoderma (PPK) is a dermatological disorder characterised by excessive thickening of the palms and soles, encompassing more than 20 conditions. The disease is often misdiagnosed in primary care settings, leading to unnecessary treatments and delays. We present the case of a 3-year-old girl with skin thickening on both her palms and soles persisting for 2 years, initially believed to be an acquired condition. Subsequent evaluation revealed a family history of similar skin lesions. This case report highlights the crucial role of family physicians in differentiating hereditary from acquired PPK, especially in settings where advanced testing is unavailable. Implementing a structured diagnostic approach at the primary care level can significantly improve patient management and reduce morbidities and healthcare costs. This case contributes to the existing knowledge in this field, where hereditary PPK remains underexplored
