Cole Disease, also known as hypopigmentation-punctate palmoplantar keratoderma syndrome, is related to dilution, pigmentary and skin disease, and has symptoms including achromia of skin An important gene associated with Cole Disease is ENPP1 (Ectonucleotide Pyrophosphatase/Phosphodiesterase 1). Affiliated tissues include skin and breast, and related phenotypes are palmoplantar keratoderma and hypopigmented macule