Granular parakeratosis explained

Specialty:Dermatology

Granular parakeratosis, also known as axillary granular parakeratosis, intertriginous granular parakeratosis, and zombie patch is a cutaneous condition characterized by brownish-red keratotic papules that can coalesce into plaques.[1]

Signs and symptoms

Granular parakeratosis frequently affects the folds and is characterized by erythema with variable degrees of hyperpigmentation. In certain people, it may also be significantly pruritic.[2]

Causes

The exact cause of granular parakeratosis is unclear.[2] The majority of reports elaborate links with skin maceration (due to occlusion,[3] warm surroundings,[4] perspiration, obesity, and recurrent washing[5]) or skin irritation from external chemicals (eg, antiperspirants, deodorants,[3] and zinc oxide). It appears to be a reactive process in the skin.[6] In case reports, exposure to benzalkonium chloride—a preservative and antiseptic used in a wide range of goods, such as medical treatments, laundry rinses, and wipes—has been suggested as a trigger.[7] There have also been reports of granular parakeratosis developing after using a depilatory lotion.[8]

Diagnosis

Granular parakeratosis skin biopsies reveal compact parakeratosis and hyperkeratosis in the stratum corneum.[9] The characteristic feature of the illness is the presence of basophilic keratohyalin granules in cells in the higher layers of the skin.[10] Most frequently, papillomatosis or an acanthotic pattern of thickening of the epidermis occurs with or without psoriasis.[9] There may also be a low-grade lymphohistiocytic infiltration.[3]

Treatment

After stopping the stimulant, some people heal on their own. Oral isotretinoin,[11] antimicrobial medications, topical glucocorticoids,[12] tretinoin,[13] and vitamin D3 derivatives have also been reported to be beneficial.[14] Additionally, successful treatments with freezing, injections of botulinum toxin, and the combination of Nd: YAG and CO2 fractional laser therapy have been reported.

See also

Further reading

External links

Notes and References

  1. Book: Rapini, Ronald P. . Bolognia, Jean L. . Jorizzo, Joseph L. . Dermatology: 2-Volume Set . Mosby . St. Louis . 2007 . 978-1-4160-2999-1 .
  2. Lin . Qingxia . Zhang . Dong . Ma . Weiyuan . Granular Parakeratosis: A Case Report . Clinical, Cosmetic and Investigational Dermatology . Informa UK Limited . 15 . 2022 . 1178-7015 . 10.2147/ccid.s371558 . free . 1367–1370. 35874456 . 9297043 .
  3. Northcutt . Alan D. . Nelson . Donna M. . Tschen . Jaime A. . Axillary granular parakeratosis . Journal of the American Academy of Dermatology . Elsevier BV . 24 . 4 . 1991 . 0190-9622 . 10.1016/0190-9622(91)70078-g . 541–544. 2033126 .
  4. G . Rodríguez . [Axillary granular parakeratosis] . Biomedica: Revista del Instituto Nacional de Salud . 2002 . Biomedica . 22 . 4 . 519–523 . 10.7705/biomedica.v22i4.1178 . 0120-4157 . 12596449 . free .
  5. Neri . Iria . Patrizi . Annalisa . Guerrini . Valentina . Fanti . Pier Alessandro . Granular Parakeratosis in a Child . Dermatology . S. Karger AG . 206 . 2 . 2003 . 1018-8665 . 10.1159/000068454 . 177–178. 12592091 . 44618750 .
  6. Ding . Catherine Y. . Liu . Hannah . Khachemoune . Amor . Granular Parakeratosis: A Comprehensive Review and a Critical Reappraisal . American Journal of Clinical Dermatology . Springer Science and Business Media LLC . 16 . 6 . 2015-08-05 . 1175-0561 . 10.1007/s40257-015-0148-2 . 495–500. 26242230 . 207482401 .
  7. Robinson . Aaron J . Foster . Rachael S . Halbert . Anne R . King . Emma . Orchard . David . Granular parakeratosis induced by benzalkonium chloride exposure from laundry rinse aids . Australasian Journal of Dermatology . Wiley . 58 . 3 . 2016-09-19 . e138–e140 . 0004-8380 . 10.1111/ajd.12551 . 27641714 . 11343/291746 . 263094709 . free .
  8. A . Samrao . M . Reis . G . Niedt . D . Rudikoff . Granular parakeratosis: response to calcipotriene and brief review of current therapeutic options . Skinmed . 2010 . 8 . 6 . 357–359 . 1540-9740 . 21413654 . 2024-03-09 .
  9. Web site: UpToDate . UpToDate . 2024-03-09.
  10. Ip . Ken Hiu-Kan . Li . Angela . Clinical features, histology, and treatment outcomes of granular parakeratosis: a systematic review . International Journal of Dermatology . Wiley . 61 . 8 . 2022-01-30 . 0011-9059 . 10.1111/ijd.16107 . 973–978. 35094385 . 9546368 .
  11. Webster . Cynthia G. . Resnik . Kenneth S. . Webster . Guy F. . Axillary granular parakeratosis: Response to isotretinoin . Journal of the American Academy of Dermatology . Elsevier BV . 37 . 5 . 1997 . 0190-9622 . 10.1016/s0190-9622(97)70119-1 . 789–790. 9366832 .
  12. Chamberlain . A. J. . Tam . M. M. . Intertriginous granular parakeratosis responsive to potent topical corticosteroids . Clinical and Experimental Dermatology . Oxford University Press (OUP) . 28 . 1 . 2003 . 0307-6938 . 10.1046/j.1365-2230.2003.01159.x . 50–52. 12558631 . 33504233 .
  13. Brown . Sonya K. . Heilman . Edward R. . Granular parakeratosis: Resolution with topical tretinoin . Journal of the American Academy of Dermatology . Elsevier BV . 47 . 5 . 2002 . 0190-9622 . 10.1067/mjd.2002.109252 . S279–S280. 12399751 .
  14. Contreras . Michael E. . Gottfried . Lisa C. . Bang . Ran H. . Palmer . Charles H. . Axillary intertriginous granular parakeratosis responsive to topical calcipotriene and ammonium lactate . International Journal of Dermatology . Wiley . 42 . 5 . 2003 . 0011-9059 . 10.1046/j.1365-4362.2003.01722.x . 382–383. 12755978 . 9695747 .