Axillary granular parakeratosis: Response to isotretinoin

Axillary Granular Parakeratosis

“…Spontaneous resolution after failed treatments has also been reported. 2,3,8 Relevant to our choice of treatments was the case reported by Webster et al 7 which cleared with oral isotretinoin. In order to limit possible systemic toxicity, our patient applied 0.1% adapalene gel to her axillae once a day and experienced marked resolution of her eruption within four weeks, without significant recurrence after 12 weeks.…”

“…Northcutt et al 1 speculated that a contact allergen, likely found in deodorants or antiperspirants, is responsible for the eruption. Other authors 3,7 have questioned this theory, citing unilateral distribution and occurrence of the eruption outside the axillae as evidence to the contrary. Mehregan et al 3 proposed that mechanical irritation in the setting of the humid environment of the intertriginous areas might lead to a protective proliferation of epidermis.…”

“…In the normal process of keratinization, profilaggrin, contained within keratohyalin granules, is broken down to filaggrin, which acts as a matrix for the aggregation of keratin filaments and is associated with the degradation of keratohyalin granules. 1,2,5,7,8 Metze and Rü tten 2 demonstrated by immunoelectron microscopy that the cytoplasm of granular parakeratotic cells was unreactive for filaggrin. This provides evidence that a defect in the processing of filaggrin probably occurs in this disorder.…”

“…[1][2][3][4][5][6][7][8][9] Reported therapeutic options have included discontinuation of deodorant or changing deodorants. Topical modalities have included steroids, antifungals, antibiotics, vitamin D derivatives, and retinoids.…”

Granular Parakeratosis in a Child

“…The response of GP to different treatments such as steroids, antibiotics and antifungal drugs is very often disappointing [7], and many cases seem to have cleared without treatment. Owing to the ineffectiveness of a mild-potency topical steroid in our case, therapy was discontinued and a spontaneous remission of the lesions was observed at the 2-month follow-up.…”