Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Granular Parakeratosis Medication

  • Author: Noah S Scheinfeld, JD, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jan 25, 2016
 

Medication Summary

The goals of pharmacotherapy for granular parakeratosis are to reduce pruritus and to improve the appearance of the eruption that manifests with granular parakeratosis.

Next

Retinoid-like Agents

Class Summary

These agents are vitamin A analogues involved in modulation of cell growth, division, reproduction, and differentiation. Their biologic effects result from alterations in gene expressions that are mediated through 2 major types of nuclear receptors: the retinoic acid receptor and the retinoic X receptor. Each receptor subtype likely controls the expression of both unique genes and common genes. Subclass-specific retinoids are available. Systemic retinoids very likely are not indicated for this harmless condition, but they could perhaps be used in exceptional cases.

Isotretinoin (Amnesteem, Claravis, Sotret)

 

Isotretinoin is an oral agent that treats serious dermatologic conditions. Isotretinoin is the synthetic 13-cis isomer of the naturally occurring tretinoin (trans -retinoic acid). Both agents are structurally related to vitamin A. Isotretinoin is a second-line treatment because it has frequent adverse effects and because topical medications can effectively treat this condition.

A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.

Tretinoin topical (Avita, Retin-A, Renova, Refissa, Tretin-X)

 

Tretinoin topical makes keratinocytes in sebaceous follicles less adherent and easier to remove. It is available as 0.025%, 0.05%, and 0.1% creams. It is also available as 0.01% and 0.025% gels. Tretinoin topical can be a first-line treatment in granular parakeratosis but is irritating and should be used with caution.

Tazarotene (Tazorac, Avage)

 

Tazarotene is a topical medication approved for psoriasis and acne. It is useful in normalizing functioning of epithelial cells. Tazarotene acts on a genetic level, leading to the transcription of certain retinoic acid genes. Use is off-label.

Previous
Next

Vitamins, Fat-Soluble

Class Summary

These agents are essential for normal DNA synthesis and metabolism of proteins, carbohydrates, and fats. They may also work as cofactors used in aerobic cellular respiration.

Calcipotriene (Dovonex, Calcitrene)

 

Calcipotriene is a topical preparation containing vitamin D-3. It is indicated for psoriasis. Calcipotriene seems to normalize maturation of epidermal cells.

Previous
Next

Topical Skin Products

Class Summary

This agent normalizes skin function.

Ammonium lactate (Lac Hydrin, AmLactin, LAClotion)

 

Ammonium lactate is a topical medication used to treat dry skin. It relieves itching and aids in healing skin in mild eczemas and dermatoses, itching skin, minor wounds, and minor skin irritations. Ammonium lactate is found in a variety of topical emollient lotions.

Previous
Next

Corticosteroids

Class Summary

These agents have both anti-inflammatory (glucocorticoid) properties and salt-retaining (mineralocorticoid) properties. Glucocorticoids have profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.

Hydrocortisone topical (CortaGel, Cortaid, Dermarest, Ala-Cort )

 

Hydrocortisone topical is an adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. It decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability. It can be a first-line treatment in this condition but can cause striae and skin thinning when used in axillary or groin areas.

Previous
 
 
Contributor Information and Disclosures
Author

Noah S Scheinfeld, JD, MD, FAAD Assistant Clinical Professor, Department of Dermatology, Weil Cornell Medical College; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Assistant Attending Dermatologist, New York Presbyterian Hospital; Assistant Attending Dermatologist, Lenox Hill Hospital, North Shore-LIJ Health System; Private Practice

Noah S Scheinfeld, JD, MD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Abbvie<br/>Received income in an amount equal to or greater than $250 from: Optigenex<br/>Received salary from Optigenex for employment.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

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

  2. Niesmann J, Bierhoff E, Dirschka T. [Hyperkeratotic pruritic papules in the submammary area. Diagnose: Granular parakeratosis]. J Dtsch Dermatol Ges. 2010 Aug. 8(8):631-3. [Medline].

  3. Leclerc-Mercier S, Prost-Squarcioni C, Hamel-Teillac D, Fraitag S. A case of congenital granular parakeratosis. Am J Dermatopathol. 2011 Jul. 33(5):531-3. [Medline].

  4. Martorell A, Sanmartín O, Hueso-Gabriel L, Guillén C. [Granular parakeratosis: disease or reactive response?]. Actas Dermosifiliogr. 2011 Jan. 102(1):72-4. [Medline].

  5. Channual J, Fife DJ, Wu JJ. Axillary granular parakeratosis. Cutis. 92(2):. 2013 Aug:61, 65-6. [Medline].

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

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

  8. Hoste E, Denecker G, Gilbert B, Van Nieuwerburgh F, van der Fits L, Asselbergh B, et al. Caspase-14-Deficient Mice Are More Prone to the Development of Parakeratosis. J Invest Dermatol. 2013 Mar. 133(3):742-50. [Medline].

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

  10. Braun-Falco M, Laaff H. Granular parakeratosis--a clinical-pathological correlation of 10 cases. J Dtsch Dermatol Ges. 2009 Apr. 7(4):340-4. [Medline].

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

  12. Brouwer MW, Kemperman PM. A female with axillary red-brown plaques. Br J Dermatol. 2013 Nov 9. [Medline].

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

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

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

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

  17. Urbina F, Sudy E, Misad C. Two episodes of axillary granular parakeratosis triggered by different causes: case report. Acta Dermatovenerol Croat. 2012. 20(2):105-7. [Medline].

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

  19. Pock L, Cermakova A, Zipfelova J, Hercogova J. Incidental granular parakeratosis associated with molluscum contagiosum. Am J Dermatopathol. 2006 Feb. 28(1):45-7. [Medline].

  20. Reddy IS, Swarnalata G, Mody T. Intertriginous granular parakeratosis persisting for 20 years. Indian J Dermatol Venereol Leprol. 2008 Jul-Aug. 74(4):405-7. [Medline].

  21. Ezra N, Karunasiri D, Chiu MW. Unilateral pruritic axillary rash: axillary granular parakeratosis. Arch Dermatol. 2008 Dec. 144(12):1651. [Medline].

  22. Akkaya AD, Oram Y, Aydın Ö. Infantile granular parakeratosis: cytologic examination of superficial scrapings as an aid to diagnosis. Pediatr Dermatol. 2015 May-Jun. 32 (3):392-6. [Medline].

  23. Chan MP, Zimarowski MJ. Vulvar dermatoses: a histopathologic review and classification of 183 cases. J Cutan Pathol. 2015 Aug. 42 (8):510-8. [Medline].

  24. Paradisi A, Sisto T, Annessi G. Groin granular parakeratosis. Eur J Dermatol. 2010 Mar-Apr. 20(2):242-3. [Medline].

  25. Niesmann J, Bierhoff E, Dirschka T. [Hyperkeratotic pruritic papules in the submammary area. Diagnose: Granular parakeratosis]. J Dtsch Dermatol Ges. 2010 Aug 1. 8(8):631-3. [Medline].

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

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

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

  29. Brouwer MW, Kemperman PM. A woman with axillary red-brown plaques. Br J Dermatol. 2014 Feb. 170(2):479-80. [Medline].

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

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

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

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

  34. Yang JH, Lee HM, Noh TK, Won CH, Chang S, Lee MW, et al. Granular parakeratosis of eccrine ostia. Ann Dermatol. 2012 May. 24:203-5. [Medline].

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

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

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

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

  39. Samrao A, Reis M, Niedt G, Rudikoff D. Granular parakeratosis: response to calcipotriene and brief review of current therapeutic options. Skinmed. 2010 Nov-Dec. 8(6):357-9. [Medline].

  40. Patel U, Patel T, Skinner RB Jr. Resolution of granular parakeratosis with topical calcitriol. Arch Dermatol. 2011 Aug. 147:997-8. [Medline].

  41. Ozkanli S, Zemheri E, Karadag AS, Akbulak O, Zenginkinet T, Zindanci I, et al. A comparative study of histopathological findings in skin biopsies from patients with psoriasis before and after treatment with acitretin, methotrexate and phototherapy. Cutan Ocul Toxicol. 2014 Sep 29. 1-6. [Medline].

 
Previous
Next
 
Granular parakeratosis in an 82-year-old man who developed this yellowish, scaly plaque at his left infra-axillary area after changing deodorants. Pathology confirmed granular parakeratosis. Courtesy of David F. Butler, MD.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.