Granular parakeratosis induced by benzalkonium chloride exposure from laundry rinse aids

Robinson, Arvin E.; Foster, Rachael S; Halbert, Anne; King, E. S. J.; Orchard, David

doi:10.1111/ajd.12551

Cited by 26 publications

(37 citation statements)

References 5 publications

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“…Future studies will need to explore how changing lifestyles, environments and even medical practices including use of cleansing agents and preservatives in topical preparations impact on the microbial communities on the human body. Some cases of granular parakeratosis have been associated with use of benzalkonium chloride . We believe that it is not a primary contact dermatitis but an alteration of the surface microbiome that leads to hyperkeratotic flexural erythema clinical picture.…”

Section: Discussionmentioning

confidence: 88%

Hyperkeratotic flexural erythema responding to amoxicillin–clavulanic acid therapy: Report of four cases

et al. 2019

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Hyperkeratotic eruptions in the flexures, especially in the inguinal region, often pose a diagnostic and therapeutic dilemma. Inguinal keratotic eruptions may be caused by various infections, inflammatory dermatoses, vesico-bullous dermatoses, nutrient deficiencies, medication allergies and other miscellaneous causes such as granular parakeratosis. We hereby report four patients who presented with idiopathic hyperkeratotic erythematous eruptions with a migratory nature involving the inguinal region and occasionally showing the histopathologic features of granular parakeratosis. All four patients showed a dramatic therapeutic response to amoxicillin-clavulanic acid combination. We suggest that 'granular parakeratosis' should be considered as a histopathologic feature rather than the diagnosis. We would prefer to label our cases as 'Hyperkeratotic Flexural Erythema'. We recommend that detailed study of skin microbiome may help identify a possible alteration in skin microbiome contributing to the pathogenesis. We briefly review strategies on characterising the skin microbiome and the latest knowledge surrounding how alterations to the skin microbial populations can contribute to some diseases.

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Section: Discussionmentioning

confidence: 88%

Hyperkeratotic flexural erythema responding to amoxicillin–clavulanic acid therapy: Report of four cases

et al. 2019

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“…Although well documented as a skin irritant, benzalkonium chloride is commonly used in hand sanitisers and household cleaning products 7,8 and has been associated with development of granular parakeratosis in the paediatric population. 9 While it is included as a contact allergen on the Australian Baseline Series (ABS), several reports 7,8 including one comparative study using an atopic mice model have identified benzalkonium chloride as a significant irritant that can cause eczematous dermatoses to a greater degree than other commonly used antiseptic agents such as povidone-iodine, ethanol and chlorhexidine gluconate. 8 In a recent case series by Robinson and colleagues 9 six children presented with granular parakeratosis secondary to benzalkonium chloride exposure following the use of antiseptic laundry rinse by Dettol (Reckitt Benckiser, Beijing, China) or Canesten (Bayer Australia, Sydney, NSW, Australia).…”

Section: Research Lettermentioning

confidence: 99%

Granular parakeratosis in an adult female secondary to exposure to benzalkonium chloride laundry rinse

Shen

Pham

Ryan³

et al. 2019

Aust J Dermatology

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However, Brewster and colleagues found a left-sided excess of melanoma exists even in countries where vehicles are driven from the right side, such as the United Kingdom and Australia. As this is inconsistent with driving-related exposure, it was theorised that this left-sided predominance may be due to anatomical or embryological asymmetry, or some unknown other difference in ultraviolet exposure. 6,7 Our study found that there was no significant laterality in the distribution of malignant and premalignant skin lesions, regardless of age, gender, site of lesion or histopathological diagnosis.Driving-related ultraviolet exposure appears to no longer be a major factor in the distribution of melanoma and nonmelanoma skin cancer. This may be due to the increasing use of air conditioning in vehicles, or to attribution error in previous research. It is possible that a larger study, including clinical components such as field UV damage and skin type and detailed demographic data such as occupation and patterns of sun exposure, may be able to further characterise any small difference in laterality of these skin lesions.

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“…It was first described in 1991 with a case series of four patients with granular parakeratosis involving the axilla 2. Since the initial case series, additional cases of granular parakeratosis have been described,3–8 including several with involvement of multiple intertriginous sites 9 10…”

Section: Descriptionmentioning

confidence: 99%

Pruritic papules in multiple intertriginous areas

2019

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Granular parakeratosis induced by benzalkonium chloride exposure from laundry rinse aids

Cited by 26 publications

References 5 publications

Hyperkeratotic flexural erythema responding to amoxicillin–clavulanic acid therapy: Report of four cases

Hyperkeratotic flexural erythema responding to amoxicillin–clavulanic acid therapy: Report of four cases

Granular parakeratosis in an adult female secondary to exposure to benzalkonium chloride laundry rinse

Pruritic papules in multiple intertriginous areas

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