Granular parakeratosis of multiple intertriginous areas

Abstract

A 60-year-old woman presented with a 4-year history of a recurrent reddish-brown macular eruption mainly involving the submammary and inguinal flexures and with transient involvement of the axillae. The eruption usually flared during winter and would settle spontaneously within a few months. At presentation, it had persisted longer than usual into the warmer weather and varied in clinical appearance over the time of observation, at times showing psoriasiform features and hyperkeratosis. Biopsy revealed features typical of granular parakeratosis. It was unresponsive to multiple topical and oral antifungal agents, oral antibiotic therapy, topical corticosteroids and emollients, but eventually resolved with a combination of 1% hydrocortisone cream and 1% clotrimazole cream to which the patient added a commercial topical vitamin E preparation.

A 42‐year‐old woman with a submammary intertrigo

“…Granular parakeratosis is a benign condition described in 1991 as a cutaneous eruption characterized by erythematous and hyperkeratotic papules of the folds. It was initially named axillary granular parakeratosis because of the most frequent localization, then other reports demonstrated other distribution: groin, submammary, abdomen, pubis, and flank . It occurs predominantly in middle‐aged women, but recently it has been described also in children and as a congenital condition.…”

“…It was initially named axillary granular parakeratosis because of the most frequent localization, then other reports demonstrated other distribution: groin, submammary, abdomen, pubis, and flank. 2,3 It occurs predominantly in middleaged women, but recently it has been described also in children and as a congenital condition. Clinical differential diagnosis includes Hailey-Hailey disease, Darier disease, lichen planus, and contact dermatitis (deodorant).…”

Pruritic papules in multiple intertriginous areas

“…Fortunately, the disease is often self-limiting 11. Treatments used with success in published case reports include topical treatment with corticosteroids, vitamin D analogues, retinoids, antifungal agents and ammonium lactate; oral treatment with retinoids, antibiotics and antifungal agents; and procedural treatment with cryotherapy and botulinum toxin injection 11 12…”

Granular Parakeratosis: A Comprehensive Review and a Critical Reappraisal

“…GP may also occur in the groin, inframammary folds, abdomen, vulva, perianal area, and lumbosacral area. Uncommon presentations include keratotic follicular papules [9,21], brown verrucous papules confined to the eccrine ostia [22], and brown macular lesions involving multiple intertriginous sites [23].…”

“…2 Histopathology of granular parakeratosis. There is a markedly compact parakeratotic stratum corneum with retained keratohyalin granules contributing to the dense basophilic color papillomatosis, but an atrophic epidermis has also been described [23]. Some cases of GP affect or involve the follicular infundibulum, displaying a widened follicular infundibulum with plugs of GP [4,9,21].…”