Granular parakeratosis, also known as axillary granular parakeratosis, intertriginous granular parakeratosis, and zombie patch is a
cutaneous condition characterized by brownish-red
keratoticpapules that can coalesce into plaques.[1]
Signs and symptoms
Granular parakeratosis frequently affects the folds and is characterized by
erythema with variable degrees of
hyperpigmentation. In certain people, it may also be significantly
pruritic.[2]
Causes
The exact cause of granular parakeratosis is unclear.[2] The majority of reports elaborate links with skin maceration (due to occlusion,[3] warm surroundings,[4] perspiration,
obesity, and recurrent washing[5]) or skin irritation from external chemicals (eg,
antiperspirants, deodorants,[6] and
zinc oxide). It appears to be a reactive process in the skin.[7] In case reports, exposure to
benzalkonium chloride—a preservative and
antiseptic used in a wide range of goods, such as medical treatments, laundry rinses, and wipes—has been suggested as a trigger.[8] There have also been reports of granular parakeratosis developing after using a depilatory lotion.[9]
Diagnosis
Granular parakeratosis
skin biopsies reveal compact
parakeratosis and
hyperkeratosis in the
stratum corneum.[10] The characteristic feature of the illness is the presence of basophilic
keratohyalin granules in cells in the higher layers of the skin.[11] Most frequently,
papillomatosis or an acanthotic pattern of thickening of the epidermis occurs with or without
psoriasis.[10] There may also be a low-grade lymphohistiocytic infiltration.[3]
^
abNorthcutt, Alan D.; Nelson, Donna M.; Tschen, Jaime A. (1991). "Axillary granular parakeratosis". Journal of the American Academy of Dermatology. 24 (4). Elsevier BV: 541–544.
doi:
10.1016/0190-9622(91)70078-g.
ISSN0190-9622.
PMID2033126.
^Northcutt, Alan D.; Nelson, Donna M.; Tschen, Jaime A. (1991). "Axillary granular parakeratosis". Journal of the American Academy of Dermatology. 24 (4). Elsevier BV: 541–544.
doi:
10.1016/0190-9622(91)70078-g.
ISSN0190-9622.
PMID2033126.
^Ding, Catherine Y.; Liu, Hannah; Khachemoune, Amor (2015-08-05). "Granular Parakeratosis: A Comprehensive Review and a Critical Reappraisal". American Journal of Clinical Dermatology. 16 (6). Springer Science and Business Media LLC: 495–500.
doi:
10.1007/s40257-015-0148-2.
ISSN1175-0561.
PMID26242230.
S2CID207482401.
^Robinson, Aaron J; Foster, Rachael S; Halbert, Anne R; King, Emma; Orchard, David (2016-09-19). "Granular parakeratosis induced by benzalkonium chloride exposure from laundry rinse aids". Australasian Journal of Dermatology. 58 (3). Wiley: e138–e140.
doi:
10.1111/ajd.12551.
hdl:11343/291746.
ISSN0004-8380.
PMID27641714.
S2CID263094709.
^Webster, Cynthia G.; Resnik, Kenneth S.; Webster, Guy F. (1997). "Axillary granular parakeratosis: Response to isotretinoin". Journal of the American Academy of Dermatology. 37 (5). Elsevier BV: 789–790.
doi:
10.1016/s0190-9622(97)70119-1.
ISSN0190-9622.
PMID9366832.
^Brown, Sonya K.; Heilman, Edward R. (2002). "Granular parakeratosis: Resolution with topical tretinoin". Journal of the American Academy of Dermatology. 47 (5). Elsevier BV: S279–S280.
doi:
10.1067/mjd.2002.109252.
ISSN0190-9622.
PMID12399751.
^Contreras, Michael E.; Gottfried, Lisa C.; Bang, Ran H.; Palmer, Charles H. (2003). "Axillary intertriginous granular parakeratosis responsive to topical calcipotriene and ammonium lactate". International Journal of Dermatology. 42 (5). Wiley: 382–383.
doi:
10.1046/j.1365-4362.2003.01722.x.
ISSN0011-9059.
PMID12755978.
S2CID9695747.
Further reading
Ravitskiy, Larisa; Heymann, Warren R. (2005). "Botulinum Toxin-Induced Resolution of Axillary Granular Parakeratosis". SKINmed: Dermatology for the Clinician. 4 (2). Wiley: 118–120.
doi:
10.1111/j.1540-9740.2005.03700.x.
ISSN1540-9740.
PMID15785142.