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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 24  |  Issue : 2  |  Page : 135-136

Infantile granular parakeratosis: Case report and review of the literature


Department of Dermatology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia

Date of Submission26-May-2020
Date of Acceptance25-Aug-2020
Date of Web Publication10-Nov-2020

Correspondence Address:
Dr. Hanan M Almeshal
Department of Dermatology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdds.jdds_28_20

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  Abstract 


Granular parakeratosis (GP) is a benign skin disease that has been reported in adults and children. Lesions usually affect the axillae, groin, and submammary region. The primary lesions present as brown keratotic papules and can form plaques. The etiologies implicated in the development of GP include the use of topical cream and the use of deodorants, local irritation and in children, it was linked to repetitive washing of the affected area and the use of zinc oxide cream. This is a case report of GP in a 14-month-old boy noted after washing the groin area with soap and using zinc oxide cream. The lesions have improved after the discontinuation of the use of zinc oxide cream and soap in washing the affected area.

Keywords: Granular parakeratosis, infantile, zinc oxide


How to cite this article:
Almeshal HM. Infantile granular parakeratosis: Case report and review of the literature. J Dermatol Dermatol Surg 2020;24:135-6

How to cite this URL:
Almeshal HM. Infantile granular parakeratosis: Case report and review of the literature. J Dermatol Dermatol Surg [serial online] 2020 [cited 2020 Dec 4];24:135-6. Available from: https://www.jddsjournal.org/text.asp?2020/24/2/135/300390




  Introduction Top


Granular parakeratosis (GP) is a skin disease that manifests as erythematous or hyperpigmented papules that developed in the intertriginous area.[1] The cause of the condition remains unclear, and the tendency of the lesions to affect the intertriginous areas suggests that physical factors can play a role in the development of the skin lesions.[2] It was hypothesized that GP develops in infants who are susceptible after being exposed to occlusion and moisture from the diaper and leads to defective maturation of the epidermis in the affected areas.[3] Other triggering factors that were implicated include topical use of zinc oxide and frequent washing of the area with liquid soap.[3],[4] The author herein describes a case of GP affecting the diaper areas in a 14-month-old boy noted after starting to wash the diaper area with soap along with the topical use of zinc oxide.


  Case Report Top


A healthy 14-month-old boy had a 2-month history of recurrent, brown warty papules and plaques affecting the inguinal fold and the buttock. The lesions were asymptomatic. The lesion was first noted when the mother started to wash the area with soap twice daily, followed by applying zinc oxide cream. He was previously treated by topical miconazole cream twice daily for 2 weeks with no much improvement noted. His medical history is unremarkable, and there was no family history of cutaneous diseases. Clinical examination of the area revealed symmetric multiple, coalescing brown papules, and linear plaques affecting the inguinal folds and the buttock [Figure 1]. The diagnosis of GP was based on characteristic clinical features and was advised to stop washing the area with soap and refrain from using zinc oxide paste. The patient noted the disappearance of the lesions after 2 weeks from stopping the habit of washing with soap and started cleaning the area with water and the discontinuation of zinc oxide paste [Figure 2].
Figure 1: (a) Brown hyperkeratotic papules and plaques affecting the inguinal folds. (b) Few brown papules affecting the gluteal area

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Figure 2: (a and b) The disappearance of the lesions after stopping the use of topical zinc oxide

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  Discussion Top


In 1991, Northcutt et al.[5] reported four women with pruritic, hyperpigmented patches affecting the axillae and proposed the term “axillary granular parakeratosis.” In 1999 Metze and Rütten.[2] reported cases involving areas such as the submammary and intermammary area, abdomen folds, and groin along with the axillae, and the term of “granular parakeratosis” was proposed in 2002, Trowers et al.[6] reported GP in a 9-months-old boy. Patrizi et al.[4] published a report of four young children with GP. Chang et al.[3] described two clinical patterns that affect the diaper area and included geometric erythematous plaques underlying areas of the pressure of the diaper and bilateral linear warty plaques affecting the inguinal folds. The exact etiology behind this condition remains unclear.

Immunohistochemical and ultrastructural studies suggest that there is defective processing of profilaggrin to filaggrin leading to the retention of the keratohyalin granules in the stratum corneum during cornification.[2] Some factors have been implicated as a triggering agent such as the use of topical zinc oxide, powder, occlusion from the diaper, and use of soap.[3],[4],[7],[8] It was proposed that patients with atopic dermatitis might be more susceptible to the development of GP due to the fact that they have disrupted skin barrier and that will lead to enhancement in the transepidermal penetration of the applied topical preparation.[9] The histopathological features of GP include the thickening of the stratum corneum and parakeratosis with retention of the keratohyalin granules.[1] It was suggested that the examination of the crust can aid the diagnosis by demonstrating the histological findings in the stratum corneum.[1],[9] Akkaya et al.[9] demonstrated that examination of the crust after performing superficial scarping from the skin lesions and identifying the presence of keratohyalin granules can serve as a noninvasive diagnostic tool in the diagnosis of GP. Treatment options of this condition are limited and included the use of topical tacrolimus, pimecrolimus, topical steroids with variable results,[3],[4] and topical keratolytic agents such as salicylic acid at concentration 3%–5% with good efficacy in eliminating the lesions.[10] The spontaneous resolution was reported in some patients after the cessation of topical zinc oxide.[9] In this reported case, the patient responded after the discontinuation of the use of topical zinc oxide.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In case of minors, patient consent have been obtained from parents or guardians. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pimentel DR, Michalany N, Morgado de Abreu MA, Petlik B, Mota de Avelar Alchorne M. Granular parakeratosis in children: Case report and review of the literature. Pediatr Dermatol 2003;20:215-20.  Back to cited text no. 1
    
2.
Metze D, Rütten A. Granular parakeratosis – A unique acquired disorder of keratinization. J Cutan Pathol 1999;26:339-52.  Back to cited text no. 2
    
3.
Chang MW, Kaufmann JM, Orlow SJ, Cohen DE, Mobini N, Kamino H. Infantile granular parakeratosis: Recognition of two clinical patterns. J Am Acad Dermatol 2004;50:S93-6.  Back to cited text no. 3
    
4.
Patrizi A, Neri I, Misciali C, Fanti PA. Granular parakeratosis: Four paediatric cases. Br J Dermatol 2002;147:1003-6.  Back to cited text no. 4
    
5.
Northcutt AD, Nelson DM, Tschen JA. Axillary granular parakeratosis. J Am Acad Dermatol 1991;24:541-4.  Back to cited text no. 5
    
6.
Trowers AB, Assaf R, Jaworsky C. Granular parakeratosis in a child. Pediatr Dermatol 2002;19:146-7.  Back to cited text no. 6
    
7.
Mehregan DA, Vandersteen P, Sikorski L, Mehregan DR. Axillary granular parakeratosis. J Am Acad Dermatol 1995;33:373-5.  Back to cited text no. 7
    
8.
Webster CG, Resnik KS, Webster GF. Axillary granular parakeratosis: Response to isotretinoin. J Am Acad Dermatol 1997;37:789-90.  Back to cited text no. 8
    
9.
Akkaya AD, Oram Y, Aydin Ö. Infantile granular parakeratosis: Cytologic examination of superficial scraping as an aid to diagnosis. Pediatr Dermatol 2015;32:392-6.  Back to cited text no. 9
    
10.
Giraldi A, Simone M, Fillus Neto J, Taniguchi Abagge K, Parolin Marinonni L, Oliveira de Carvalho V, et al. Granular parakeratosis: A report of six cases in children. An Bras Dermatol 2006;81:59-64.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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