Granular Parakeratosis Clinical Presentation

Updated: Dec 13, 2019
  • Author: Sheevam A Shah, MD; Chief Editor: Dirk M Elston, MD  more...
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Patients typically present with a 1- to 12-month history of axillary or intertriginous rash. Sometimes, the rash is pruritic; sometimes, it is not.

In 2005, Scheinfeld and Mones [16] demonstrated that granular parakeratosis usually occurs in women in their axillae. Patients may report a history of applying antiperspirants and deodorants in the immediate period before the rash started. In 2003, Contreras et al [26] noted that a 70-year-old man reported a burning sensation in the area of granular parakeratosis.

In another report, mothers reported changing their granular parakeratosis infants' diapers 5-7 times daily. The mothers reported thoroughly washing the area with liquid soap after every diaper change. The mothers also always applied zinc oxide powders and/or pastes to the affected areas. [14] Similarly, a report in 2012 from Chile noted granular parakeratosis occurring after axillary irritation due to an antiperspirant and perhaps the use of a zinc oxide paste, which resolved with calcipotriol and then reoccurred 2 years later in the patient, 20 kg greater in weight, in the bilateral axilla, with no presence of irritation but with use of the same antiperspirant. [27]

In 2019, Flora and Whitfeld [18] reported an unusual presentation of granular parakeratosis and concurrent red scrotum syndrome in a 27-year-old man. The patient presented with an exquisitely painful scrotal rash and bilateral hyperkeratotic plaques in the inguinal region.

In 2002, Rodriguez [21] reported three cases in obese women.

A number of incidental incidences of granular parakeratosis have been reported, including associations with dermatomyositis [28] and molluscum contagiosum. [29] The case of molluscum contagiosum involved a woman with trunk and extremity involvement after a 4-month history of a slowly progressive pruritic papular eruption.

Reddy et al noted a case of granular parakeratosis of 20 years’ duration. [30]

Granular parakeratosis can be unilateral. [31]

In children, it can be caused by topical products that impair the integrity of the skin and is thus perhaps more common in atopic skin. [2, 32]

Granular parakeratosis is a rare cause of vulvar dermatosis, accounting for 0.5% of cases in a series of 183 cases. [33]


Physical Examination

Granular parakeratosis manifests with intertriginous (ie, axillary, groin, intermammary or submammary region, and abdominal folds) bilateral or unilateral brown- or red-crusted patches, papules, or plaques. The primary lesions are keratotic brownish-red papules that can have a conical shape. They can coalesce into larger well-demarcated plaques with various degrees of maceration secondary to local occlusion. The rash can be confluent or reticulated. Even when patches or plaques are present, discrete papules can also be present. Granular parakeratosis can appear as slightly erythematous and lichenified plaques.

In children, granular parakeratosis has been reported to occur in the groin, on the lower back, on the buttocks, and on the flanks. [2] Granular parakeratosis can also occur in the groin area in adults. [18, 34] Granular parakeratosis has also been reported under the breast. [4, 25, 35] In one case, granular parakeratosis developed across the neck and anterior chest. [15]

Granular parakeratosis reportedly can occur as a solitary keratosis, which is termed granular parakeratotic acanthoma. This appears to be in the same family as acantholytic dyskeratotic acanthoma and epidermolytic acanthoma. [36]

Granular parakeratosis manifesting as facial keratotic papules has been reported. [37]

Genebriera et al [38] noted a papillomatous axillary rash due to granular parakeratosis.

Axillary red-brown bilateral plaques can be a manifestation of granular parakeratosis. [39]