What are the other Names for this Condition? (Also known as/Synonyms)

• Hyperkeratotic Flexural Erythema

What is Granular Parakeratosis? (Definition/Background Information)

• Granular Parakeratosis is a rare skin condition resulting in red scaly skin mainly in the flexural regions (skin folds) of the body. The condition is commonly observed to affect the armpits of middle-aged women
• The cause of the condition is believed to be a combination of genetic and environmental factors. An exposure to the chemical benzalkonium chloride that is found in cosmetics and laundry agents is known to cause some cases of Granular Parakeratosis
• A treatment of Granular Parakeratosis may involve topical steroids, keratolytic agents, cryotherapy, and oral medications, if necessary. The prognosis is generally good with adequate treatment

Who gets Granular Parakeratosis? (Age and Sex Distribution)

• Granular Parakeratosis are generally observed in adults during middle age; but, it may be observed in infants, children, and adults of any age range
• Both males and females are affected, although many cases are observed in women
• Worldwide, there is no racial or ethnic preference observed

What are the Risk Factors for Granular Parakeratosis? (Predisposing Factors)

The risk factors for Granular Parakeratosis may include:

• Use of cosmetics and house cleaning products having a certain chemical antiseptic known as benzalkonium chloride is thought to induce the condition in some cases
• Middle-aged women seem to have a higher risk for Granular Parakeratosis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Granular Parakeratosis? (Etiology)

Granular Parakeratosis is believed to be caused from certain genetic and environmental factors (such as contact allergens), which are provoked by:

• Skin friction - skin rubbing on skin causing breakdown of skin layers
• Increased temperature between the skin folds (flexures)
• Sweaty skin and impediment in sweat evaporation
• Overgrowth of skin microbiome, the naturally-residing bacteria, yeast, and other microorganisms on skin

Abnormalities in the production of a certain protein, termed filaggrin, due to genetic factors is thought to increase the risk for this condition.

What are the Signs and Symptoms of Granular Parakeratosis?

The signs and symptoms of Granular Parakeratosis may include:

• Presence of skin rashes that resemble intertrigo, which is usually observed at body skin folds, most often at the armpits
• The rashes may be observed at other non-flexural folds too
• Severe cases of Granular Parakeratosis may cover large surfaces of the body/trunk
• The skin lesions are present as red to brown scaly patches
• In some individuals, itching of the lesions is noted
• During healing, the skin is seen to peel away

How is Granular Parakeratosis Diagnosed?

A diagnosis of Granular Parakeratosis may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Blood tests, analysis of pus, culture of the fluid being drained (for causative pathogen), as needed
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

A skin tissue biopsy is important in establishing the diagnosis of Granular Parakeratosis.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Granular Parakeratosis?

The possible complications due to Granular Parakeratosis include:

• Emotional stress due to cosmetic issues
• Severe discomfort
• Superimposed bacterial and fungal skin infections
• Recurrence of the condition
• Treatment complications

How is Granular Parakeratosis Treated?

The treatment measures available for Granular Parakeratosis may include:

• Use of topical retinoids and steroids, as necessary
• Treating secondary infections via antifungal or antibiotic creams
• Use of keratolytic agents
• Cold therapy or cryotherapy
• Oral medications, if needed
• Botulinum toxin injections

Regular follow up visits with the healthcare provider is important and recommended.

How can Granular Parakeratosis be Prevented?

• Presently, Granular Parakeratosis may not be prevented in many cases
• However, in some cases, avoiding the use of certain cosmetics and laundry agents (that contain benzalkonium chloride) may help prevent the condition

What is the Prognosis of Granular Parakeratosis? (Outcomes/Resolutions)

• The prognosis of Granular Parakeratosis is generally good with adequate treatment. The response to treatment may be variable, and the condition may get better within 1-12 months
• If the condition develops from exposure to certain home-cleaning agents or cosmetics, then Granular Parakeratosis is known to resolve by its own, usually within a few weeks

Additional and Relevant Useful Information for Granular Parakeratosis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/