Hyperkeratotic flexural erythema (HKFE), also termed granular parakeratosis (GP), is a rare skin condition thought to be linked to a skin barrier dysfunction process, however the exact cause of this is yet to be determined. Management options are varied, with no consensus on treatment. Several previous reports have recorded successful treatment with amoxycillin-clavulanic acid combination. We propose the use of oral doxycycline in addition to topical coconut oil compound as a treatment option in therapy resistant HKFE.