PERP and Hyperkeratosis: We did not detect any pathogenic sequence alterations in palmoplantar hyperkeratosis-related genes such as KRT1, GJB2, LOR, SLURP1, MBTPS2, PERP, or CTSC. Thus, we consider that the patient is likely an atypical OS caused by p.Val306Met mutation in TPRV3. While bioinformatics predictions provide valuable insights, they are not definitive.