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Granular parakeratosis

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Granular parakeratosis
SpecialtyDermatology

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

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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

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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

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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

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After stopping the stimulant, some people heal on their own.[2] 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.[2]

See also

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References

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  1. ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
  2. ^ a b c d Lin, Qingxia; Zhang, Dong; Ma, Weiyuan (2022). "Granular Parakeratosis: A Case Report". Clinical, Cosmetic and Investigational Dermatology. 15. Informa UK Limited: 1367–1370. doi:10.2147/ccid.s371558. ISSN 1178-7015. PMC 9297043. PMID 35874456.
  3. ^ a b c Northcutt, Alan D.; Nelson, Donna M.; Tschen, Jaime A. (1991). "Axillary granular parakeratosis". Journal of the American Academy of Dermatology. 24 (4). Elsevier BV: 541–544. doi:10.1016/0190-9622(91)70078-g. ISSN 0190-9622. PMID 2033126.
  4. ^ G, Rodríguez (2002). "[Axillary granular parakeratosis]" (PDF). Biomedica: Revista del Instituto Nacional de Salud. 22 (4). Biomedica: 519–523. doi:10.7705/biomedica.v22i4.1178. ISSN 0120-4157. PMID 12596449.
  5. ^ Neri, Iria; Patrizi, Annalisa; Guerrini, Valentina; Fanti, Pier Alessandro (2003). "Granular Parakeratosis in a Child". Dermatology. 206 (2). S. Karger AG: 177–178. doi:10.1159/000068454. ISSN 1018-8665. PMID 12592091. S2CID 44618750.
  6. ^ Ding, Catherine Y.; Liu, Hannah; Khachemoune, Amor (2015-08-05). "Granular Parakeratosis: A Comprehensive Review and a Critical Reappraisal". American Journal of Clinical Dermatology. 16 (6). Springer Science and Business Media LLC: 495–500. doi:10.1007/s40257-015-0148-2. ISSN 1175-0561. PMID 26242230. S2CID 207482401.
  7. ^ Robinson, Aaron J; Foster, Rachael S; Halbert, Anne R; King, Emma; Orchard, David (2016-09-19). "Granular parakeratosis induced by benzalkonium chloride exposure from laundry rinse aids". Australasian Journal of Dermatology. 58 (3). Wiley: e138 – e140. doi:10.1111/ajd.12551. hdl:11343/291746. ISSN 0004-8380. PMID 27641714. S2CID 263094709.
  8. ^ A, Samrao; M, Reis; G, Niedt; D, Rudikoff (2010). "Granular parakeratosis: response to calcipotriene and brief review of current therapeutic options". Skinmed. 8 (6): 357–359. ISSN 1540-9740. PMID 21413654. Retrieved 2024-03-09.
  9. ^ a b "UpToDate". UpToDate. Retrieved 2024-03-09.
  10. ^ Ip, Ken Hiu-Kan; Li, Angela (2022-01-30). "Clinical features, histology, and treatment outcomes of granular parakeratosis: a systematic review". International Journal of Dermatology. 61 (8). Wiley: 973–978. doi:10.1111/ijd.16107. ISSN 0011-9059. PMC 9546368. PMID 35094385.
  11. ^ Webster, Cynthia G.; Resnik, Kenneth S.; Webster, Guy F. (1997). "Axillary granular parakeratosis: Response to isotretinoin". Journal of the American Academy of Dermatology. 37 (5). Elsevier BV: 789–790. doi:10.1016/s0190-9622(97)70119-1. ISSN 0190-9622. PMID 9366832.
  12. ^ Chamberlain, A. J.; Tam, M. M. (2003). "Intertriginous granular parakeratosis responsive to potent topical corticosteroids". Clinical and Experimental Dermatology. 28 (1). Oxford University Press (OUP): 50–52. doi:10.1046/j.1365-2230.2003.01159.x. ISSN 0307-6938. PMID 12558631. S2CID 33504233.
  13. ^ Brown, Sonya K.; Heilman, Edward R. (2002). "Granular parakeratosis: Resolution with topical tretinoin". Journal of the American Academy of Dermatology. 47 (5). Elsevier BV: S279 – S280. doi:10.1067/mjd.2002.109252. ISSN 0190-9622. PMID 12399751.
  14. ^ Contreras, Michael E.; Gottfried, Lisa C.; Bang, Ran H.; Palmer, Charles H. (2003). "Axillary intertriginous granular parakeratosis responsive to topical calcipotriene and ammonium lactate". International Journal of Dermatology. 42 (5). Wiley: 382–383. doi:10.1046/j.1365-4362.2003.01722.x. ISSN 0011-9059. PMID 12755978. S2CID 9695747.

Further reading

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