We report a case of disseminated superficial actinic porokeratosis (DSAP) with neutrophilic pustules within cornoid lamellae on histopathologic examination, corresponding to pustules along the elevated rim clinically as well. A review of the literature identified only one other case in which pustules have been associated with porokeratosis. Our case represents an unusual variant of DSAP, which may make an ordinarily straightforward clinical diagnosis more challenging. Miller DD, Ruben BS. Pustular porokeratosis.