What is Granular Parakeratosis?
Granular parakeratosis is a rare and harmless skin condition that isn’t a distinct disease, but more of a reaction the skin has to certain stimuli. It typically causes red-to-brown, scaly or thickened patches or bumps, often occurring in areas where skin touches skin. People of all ages can get it, but it’s seen more often in women than men.
It was once thought to be caused by reactions to products we use for personal cleanliness, like deodorants or antiperspirants. However, this idea was discredited when cases started showing up in areas with no exposure to these products. The term “granular parakeratosis” was first introduced in 1991, with the description of “axillary granular parakeratosis” for cases on the underarm skin.
It’s also been seen on other parts of the body where skin rubs together, and even on parts where it doesn’t, like the face. Interestingly, this skin condition usually disappears on its own within a month to a year. However, responses to treatment can vary from person to person.
What Causes Granular Parakeratosis?
Granular parakeratosis is a skin condition initially recognized in the underarm region but has been found to affect other areas of the body where skin tends to fold and overlap. Originally, it was believed that this condition was a skin reaction to personal hygiene products like deodorants and antiperspirants. However, there have been cases where affected individuals didn’t use these products, proving that they’re not the main cause.
Still, the possibility of granular parakeratosis being a unique reaction to other skin lotions or creams hasn’t been entirely ruled out. It seems there could be a link to ‘occlusion’ or blockage, given that the condition often occurs in places where skin folds over itself, creating a closed-in or occluded area. Interestingly, reports have found that when the occlusion is removed, the condition gets better.
Additional reports indicate that granular parakeratosis has occurred on areas of the body that aren’t typically occluded, like the face. This suggests that occlusion isn’t the only contributing factor. In terms of infections caused by bacteria or fungus, there hasn’t been enough evidence to confirm them as a cause. Yet, some cases have shown improvement with oral antibiotics such as amoxicillin-clavulanate.
Because the condition doesn’t consistently respond to various treatments, there isn’t enough clinical evidence to definitively explain why it arises, and patient history tends to vary, granular parakeratosis is currently classified as an ‘idiopathic’ condition, meaning its cause is unknown.
Risk Factors and Frequency for Granular Parakeratosis
Granular parakeratosis is a rare condition that can occur at any age, though it’s most often seen in adults. It’s more frequently found in women than men and doesn’t seem to be more common in any specific geographic area or racial group. A study found that only 18 out of 363,343 examined specimens showed granular parakeratosis. Some experts suggest that the condition may be linked to obesity, as it often shows up in overlapping skin folds and covered areas of the body. However, granular parakeratosis is not known to be connected to any comprehensive body diseases.
Signs and Symptoms of Granular Parakeratosis
Granular parakeratosis is a skin condition where the patients may get itchy bumps or patches in areas where the skin folds, such as underarms, under the breasts, abdominal folds, or groin area. This condition can develop over a few days to months on previously normal skin. Usually, these skin patches or bumps are red to brown in color and may appear as scaly to hard bumps that can merge into patches.
In children, there are two main ways this condition can present itself. One way is as linear patches in the folds of both groin areas with a flaky scale. The other is as geometric patches in areas under pressure from wearing diapers. Diapers may contribute to the development of granular parakeratosis in infants, but the exact reasons are still unclear.
- Itchy bumps or patches in skin fold areas
- Red to brown color
- Patches or bumps can merge into a larger one
- In children, patches may appear in both groin areas or in areas under pressure from diapers
Testing for Granular Parakeratosis
Granular parakeratosis is a skin condition that can sometimes be mistaken for several others. These may include Hailey-Hailey disease (a genetic disorder that causes blisters), warts, contact dermatitis (itchy, inflamed skin), acanthosis nigricans (dark, thickened patches of skin), erythrasma (red, slightly scaly patches on the skin), confluent and reticulated papillomatosis (bumps on the skin), extramammary Paget disease (a rare skin disorder), among others. In some cases, it was found along with other conditions, such as tinea corporis, a type of fungal infection.
So, to make sure whether you have granular parakeratosis or not, your doctor might perform a punch or a shave biopsy, where a small piece of skin is removed for further examination under a microscope using a technique called histopathology. This helps in studying the microscopic structure of tissues, and helps confirm the diagnosis.
The biopsy is then stained with hematoxylin and eosin (H&E), a common staining technique used to highlight important features of tissues and cells. This method is usually enough to confirm granular parakeratosis. What’s found in the biopsy is an unusually thick outer layer of the skin, called stratum corneum, along with an abnormal buildup of keratohyalin granules, which are the tiny particles within skin cells that play a role in skin’s natural shedding process. In addition, the stratum granulosum, another layer of the skin, remains intact under these conditions.
Taking a biopsy can also show whether granular parakeratosis is just a response to some other reaction or condition in your body, or whether it is accompanied by other conditions, such as the fungal infection tinea corporis, that can be treated separately.
Treatment Options for Granular Parakeratosis
Granular parakeratosis is a skin condition and treating it can be quite challenging. Different treatments have been tried in the past, but the results can vary greatly and may not always be successful. The tricky part is that it’s thought that this skin issue might occur as a response to certain personal care products or topical creams.
Usually, the first plan of action includes stopping the use of these products and prescribing a cream that contains steroids. These creams might help reduce itching in patients who experience this symptom. However, it’s rare for the condition to go away entirely with just the use of these creams.
Sometimes, different products might be tried. For example, there have been instances where a cream with tretinoin helped clear axillary granular parakeratosis (a type found in the armpits) in just five days. In another case, a calcitriol ointment proved useful and cleared the symptoms in the armpits in ten days. More intense treatments have also led to success. For instance, granular parakeratosis was successfully treated with a medication that’s taken orally, isotretinoin, according to one report.
For patients with a variant known as submammary granular parakeratosis, which appears beneath the breasts, surgical management may be considered. One report mentioned that a patient had a completely successful outcome following elective mastopexy, a type of breast lift surgery.
Overall, the varied success rates with different treatment strategies highlight the complexities associated with granular parakeratosis and indicate that a personalized approach is necessary when managing this skin condition.
What else can Granular Parakeratosis be?
There are several skin conditions that present with similar symptoms. These conditions include:
- Hailey-Hailey disease
- Verruca (warts)
- Contact dermatitis (skin irritation)
- Acanthosis nigricans (dark, thickened patches of skin)
- Erythrasma (fungal skin infection)
- Confluent and reticulated papillomatosis (skin disorder causing patches)
- Extramammary Paget disease (rare skin cancer)
- Inverse psoriasis (psoriasis in body folds)
- Pemphigus veterans (autoimmune skin condition)
- Bowen disease (early form of skin cancer)
What to expect with Granular Parakeratosis
Granular parakeratosis is a skin condition that often gets better on its own, typically within a month to a year. However, there have been recorded instances where it continues or repeatedly comes back for up to 20 years. You don’t have to worry about it being linked with cancer or any systematic diseases. This condition seems to be more common in overweight individuals or those with excessive skin folds.
Possible Complications When Diagnosed with Granular Parakeratosis
Granular parakeratosis is a skin condition that has not been reported to lead to cancer. However, it can lead to secondary bacterial infections on the skin, particularly in cases where patients have itchy skin lesions that are scratched open. This skin condition often co-exists with other common skin conditions such as ringworm.
Common Characteristics:
- Does not morph into cancer
- Can lead to secondary bacterial infections on the skin
- Often occurs alongside other skin conditions like ringworm
Preventing Granular Parakeratosis
Patients should be made aware that granular parakeratosis, a skin condition, is harmless and often goes away on its own. It’s also important for patients to understand that reactions to treatments can vary greatly, and there isn’t a guaranteed cure for this condition.
