Granular parakeratosis R23.4

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 02.10.2023

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Synonym(s)

granular parakeratosis; granular verrucosis; granulomatous parakeratosis

History
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Northcutt, 1991; Intertriginous granular parakeratosis, Mehregan 1998;

Definition
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Rare, circumscribed, sloppy, itchy, self-limited cornification anomaly with characteristic histological aspect occurring in intertrignial zones. The clinical picture is controversial as an entity. To what extent it is identical with a " pomade crust" is not conclusively clarified.

Occurrence/Epidemiology
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So far, less than 100 cases have been described worldwide since the initial description.

Etiopathogenesis
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Unknown; a dermatophyte-induced form has been described; a disorder in filaggrin metabolismu is discussed.

Manifestation
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Primarily described exclusively in women of colour (average age about 60 years). Isolated reports also exist in adolescents and children (inguinal localisation).

Localization
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Preferably located in the axles. Occurrence is also described in other intertriginous zones (submammary, inguinal, overlapping abdominal folds, popliteal fossa).

Clinical features
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The primary changes are itchy, oval, hyperkeratotic, brown, lichenoid papules. Later on, there are sharply delineated, itchy, brown-black, 2-7 cm large verrucous plaques limited to the intertriginous zone, occurring unilaterally or symmetrically. The vegetation tends to macerate with a corresponding foetus. Formation of erosions and rhagades. Spontaneous healings after 2-3 months have been observed as well as recurrent processes.

Histology
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On the surface, a powerfully thickened, compact stratum corneum with flattened core fragments is impressive. A prominent histological phenomenon are retentions of basophilic keratohyalin granules, which are included in the parakeratotic horn masses (picture of "polluted hyperkeratosis").

Diagnosis
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Clinic, histology.

Differential diagnosis
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External therapy
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Topical glucocorticoids possibly alternating with antimycotics.

Note(s)
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Remember! The entity of this disease first described in 1991 is disputed!

Literature
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  1. Braun-Falco M et al (2009) Granular parakeratosis - a clinically pathological correlation in hand 10 patients. JDDG 7: 340-344
  2. Chang MW et al (2004) Infantile granular parakeratosis: recognition of two clinical patterns. J Am Acad Dermatol 50(5 Suppl): 93-96
  3. Contreras ME et al (2003) Axillary intertriginous granular parakeratosis responsive to topical calcipotriene and ammonium lactate. Int J Dermatol 42: 382-383
  4. English JC et al (2003) Axillary granular parakeratosis. J Cutan Med Surg 7: 330-332
  5. Martin-Garcia RF et al (2003) Granular parakeratosis. Bol Asoc Med P R 95: 43-46
  6. Northcutt AD et al (1991) Granular verrucosis. J Am Acad Dermatol 24: 541-544
  7. Pimentel DR et al (2003) Granular parakeratosis in children: case report and review of the literature. Pediatric Dermatol 20: 215-220
  8. Resnik KS, DiLeonardo M (2003) Follicular granular parakeratosis. At J Dermatopathol 25: 428-429
  9. Woodhouse JG (2004) Granular parakeratosis. Pediatric Dermatol 21: 684

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 02.10.2023