eMedicine Specialties > Dermatology > Papulosquamous Diseases

Granular Parakeratosis: Differential Diagnoses & Workup

Author: Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, New York Medical College-Metropolitan Hospital; Private Practice
Contributor Information and Disclosures

Updated: Jan 29, 2008

Differential Diagnoses

Acanthosis Nigricans
Bowen Disease
Confluent and Reticulated Papillomatosis
Erythrasma
Extramammary Paget Disease

Other Problems to Be Considered

Inverse psoriasis
Inverse lichen planus
Inverse pityriasis rosea
Pemphigus vegetans
Benign familial pemphigus

Workup

Laboratory Studies

A potassium hydroxide preparation can be used to check for fungus.

Other Tests

A Wood lamp can be used to check for erythrasma.

Procedures

A skin biopsy is the most useful test in establishing the diagnosis of granular parakeratosis.

Histologic Findings

Characteristic histologic findings include psoriasiform hyperplasia, a thickened stratum corneum with retention of keratohyalin granules, and parakeratosis.15 Most investigators report a well-developed granular layer and a sparse lymphohistiocytic inflammatory infiltrate. The retained granular layer sometimes demonstrates focal vacuolization.

  • In 2003, Resnik and DiLeonardo16 described a follicular granular parakeratosis that was a granular parakeratosis confined to the follicle.
  • In 2004, Resnik et al17 described dermatophyte-related granular parakeratosis.
  • Incidental granular parakeratosis has been associated with carcinomas,18 dermatomyositis,10 and molluscum contagiosum.11
  • Resnik et al12 have noted the existence of a granular parakeratotic acanthoma.

More on Granular Parakeratosis

Overview: Granular Parakeratosis
Differential Diagnoses & Workup: Granular Parakeratosis
Treatment & Medication: Granular Parakeratosis
Follow-up: Granular Parakeratosis
References
[ CLOSE WINDOW ]

References

  1. Northcutt AD, Nelson DM, Tschen JA. Axillary granular parakeratosis. J Am Acad Dermatol. Apr 1991;24(4):541-4. [Medline].

  2. Metze D, Rütten A. Granular parakeratosis - a unique acquired disorder of keratinization. J Cutan Pathol. Aug 1999;26(7):339-52. [Medline].

  3. Wallace CA, Pichardo RO, Yosipovitch G, Hancox J, Sangueza OP. Granular parakeratosis: a case report and literature review. J Cutan Pathol. May 2003;30(5):332-5. [Medline].

  4. Scheinfeld NS, Mones J. Granular parakeratosis: pathologic and clinical correlation of 18 cases of granular parakeratosis. J Am Acad Dermatol. May 2005;52(5):863-7. [Medline].

  5. Rodriguez G. [Axillary granular parakeratosis]. Biomedica. Dec 2002;22(4):519-23. [Medline].

  6. Patrizi A, Neri I, Misciali C, Fanti PA. Granular parakeratosis: four paediatric cases. Br J Dermatol. Nov 2002;147(5):1003-6. [Medline].

  7. Trowers AB, Assaf R, Jaworsky C. Granular parakeratosis in a child. Pediatr Dermatol. Mar-Apr 2002;19(2):146-7. [Medline].

  8. Chang MW, Kaufmann JM, Orlow SJ, Cohen DE, Mobini N, Kamino H. Infantile granular parakeratosis: recognition of two clinical patterns. J Am Acad Dermatol. May 2004;50(5 Suppl):S93-6. [Medline].

  9. Contreras ME, Gottfried LC, Bang RH, Palmer CH. Axillary intertriginous granular parakeratosis responsive to topical calcipotriene and ammonium lactate. Int J Dermatol. May 2003;42(5):382-3. [Medline].

  10. Pock L, Hercogová J. Incidental granular parakeratosis associated with dermatomyositis. Am J Dermatopathol. Apr 2006;28(2):147-9. [Medline].

  11. Pock L, Cermáková A, Zipfelová J, Hercogová J. Incidental granular parakeratosis associated with molluscum contagiosum. Am J Dermatopathol. Feb 2006;28(1):45-7. [Medline].

  12. Resnik KS, Kantor GR, DiLeonardo M. Granular parakeratotic acanthoma. Am J Dermatopathol. Oct 2005;27(5):393-6. [Medline].

  13. Joshi R, Taneja A. Granular parakeratosis presenting with facial keratotic papules. Indian J Dermatol Venereol Leprol. Jan-Feb 2008;74(1):53-5. [Medline].

  14. Genebriera J, Davis MD, Yang H, Borrowman TA. Papillomatous axillary rash due to granular parakeratosis. J Eur Acad Dermatol Venereol. Aug 2007;21(7):994-5. [Medline].

  15. Mehregan DA, Vandersteen P, Sikorski L, Mehregan DR. Axillary granular parakeratosis. J Am Acad Dermatol. Aug 1995;33(2 Pt 2):373-5. [Medline].

  16. Resnik KS, DiLeonardo M. Follicular granular parakeratosis. Am J Dermatopathol. Oct 2003;25(5):428-9. [Medline].

  17. Resnik KS, Kantor GR, DiLeonardo M. Dermatophyte-related granular parakeratosis. Am J Dermatopathol. Feb 2004;26(1):70-1. [Medline].

  18. Resnik KS, DiLeonardo M. Incidental granular parakeratotic cornification in carcinomas. Am J Dermatopathol. Jun 2007;29(3):264-9. [Medline].

  19. Brown SK, Heilman ER. Granular parakeratosis: resolution with topical tretinoin. J Am Acad Dermatol. Nov 2002;47(5 Suppl):S279-80. [Medline].

  20. Compton AK, Jackson JM. Isotretinoin as a treatment for axillary granular parakeratosis. Cutis. Jul 2007;80(1):55-6. [Medline].

  21. Webster CG, Resnik KS, Webster GF. Axillary granular parakeratosis: response to isotretinoin. J Am Acad Dermatol. Nov 1997;37(5 Pt 1):789-90. [Medline].

  22. Ravitskiy L, Heymann WR. Botulinum toxin-induced resolution of axillary granular parakeratosis. Skinmed. Mar-Apr 2005;4(2):118-20. [Medline].

  23. Barnes CJ, Lesher JL Jr, Sangueza OP. Axillary granular parakeratosis. Int J Dermatol. Jul 2001;40(7):439-41. [Medline].

  24. Mehregan DA, Thomas JE, Mehregan DR. Intertriginous granular parakeratosis. J Am Acad Dermatol. Sep 1998;39(3):495-6. [Medline].

  25. Srivastava M, Cohen D. Axillary granular parakeratosis. Dermatol Online J. 2004;10(3):20. [Medline].

  26. Woodhouse JG, Bergfeld W. Granular parakeratosis. Pediatr Dermatol. Nov-Dec 2004;21(6):684. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

axillary granular parakeratosis, intertriginous parakeratosis, AGP, GP

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, New York Medical College-Metropolitan Hospital; Private Practice
Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Peter Fritsch, MD, Chair, Department of Dermatology and Venereology, University of Innsbruck, Austria
Peter Fritsch, MD is a member of the following medical societies: American Dermatological Association, International Society of Pediatric Dermatology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey J Miller, MD, Associate Professor, Department of Dermatology, Penn State University, Milton S Hershey Medical Center
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.