Kyrle’s disease is an acquired perforating dermatosis that is frequently associated with an underlying disorder, such as diabetes mellitus or chronic renal failure. The disease presents as multiple discrete, eruptive papules with a central crust or plug, often on the lower extremities. Histologically, a keratotic plug in an atrophic epidermis is observed and may penetrate the papillary dermis. Importantly, transdermal elimination of keratotic material with no collagen or elastic fibers is noted. Although several therapies have been suggested, the course of Kyrle’s disease is often chronic. This article reports an illustrative case of Kyrle’s disease and reviews the literature on diagnosis and management.