To the Editor.— Recently I treated a patient with hyperkeratosis of the nipples who does not seem to fit the Levy-Franckel classification (Paris Med28:63-66, 1938) reviewed by Mehregan and Rahbari in their report of two cases in the DecemberArchives(113:1691-1692, 1977). Report of a Case.— An 18-year-old girl, who was a recent high-school graduate, was referred because of crusting of her nipples of two years' duration. Her condition had been treated by her family physician with a topical preparation, but without benefit. A dermatologist prescribed an antibiotic preparation taken orally, but again, there was no response. The patient was seen at a nearby university medical center but she refused biopsy of the nipple. There was no family or personal history of ichthyosis nor any other dermatologic or familial disorders. Menstruation had been normal since age 14 and had no effect on the nipple lesions. General physical examinations disclosed