eMedicine Specialties > Dermatology > Papulosquamous Diseases
Granular Parakeratosis: Treatment & Medication
Updated: Jan 29, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
Although some consider the condition rare, successful medical treatments for granular parakeratosis have been reported. These have included topical corticosteroids and oral and topical retinoids.19,20 A 2003 report notes that topical calcipotriene and ammonium lactate also effectively treated this condition.9 Calcineurin inhibitors and topical antifungal agents have been tried with some success. Isotretinoin20,21 and tretinoin19 have been reported as effective for the condition, as has botulinum toxin injection.22
Surgical Care
Rare reports have noted that cryotherapy can effectively treat granular parakeratosis.
Activity
Patients should avoid excessive washing of intertriginous areas. They should also minimize or avoid the use of roll-on deodorants and antiperspirants.
Medication
The goals of pharmacotherapy are to reduce pruritus and to improve the appearance of the eruption that manifests with granular parakeratosis.
Retinoids
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.
The article " Clinical Review: Topical Retinoids " may also be helpful.
Isotretinoin (Accutane)
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.
Adult
Some have suggested a dose of 0.5-1 mg/kg/d PO until the condition resolves, but, if used, dose should not exceed 20 mg/d
Pediatric
Not recommended
Toxicity may occur with vitamin A coadministration; pseudotumor cerebri or papilledema may occur when coadministered with tetracyclines; may reduce carbamazepine plasma levels
Documented hypersensitivity; pregnancy
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
May decrease night vision; inflammatory bowel disease may occur; may be associated with development of hepatitis; occasional exaggerated healing response of acne lesions (excessive granulation with crusting) may occur; patients with diabetes may experience problems in controlling blood glucose levels while on isotretinoin; avoid exposure to UV light or sunlight until tolerance achieved; discontinue treatment if rectal bleeding, abdominal pain, or severe diarrhea occur; mood swings or depression may occur; caution if history of depression
Tretinoin (Avita, Retin-A, Renova)
Inhibits microcomedo formation and eliminates existing lesions. Makes keratinocytes in sebaceous follicles less adherent and easier to remove. Available as 0.025%, 0.05%, and 0.1% creams. Also available as 0.01% and 0.025% gels. Can be a first-line treatment in granular parakeratosis but is irritating and should be used with caution.
Adult
Apply topically qd
Pediatric
Not established
Other skin irritants (eg, astringents, benzoyl peroxide, salicylic acid, resorcinol, topical sulfur, other keratolytics, abrasives, spices, lime) may exacerbate irritation; coadministration with other drugs causing photosensitivity (eg, tetracycline, sulfonamides) may increase risk of sunburn
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with excessive sunlight exposure; burning, stinging, peeling, pruritus, or erythema has been reported at site of application; caution with eczema (may cause severe irritation); do not apply to mucous membranes, mouth, and angles of nose
Tazarotene (Tazorac)
Topical medication approved for psoriasis and acne. Useful in normalizing functioning of epithelial cells. Acts on a genetic level, leading to the transcription of certain retinoic acid genes. Use is off-label.
Adult
Apply to rash qd
Pediatric
Apply as in adults
Do not use concomitantly with dermatologic drugs or cosmetics that have a strong drying effect on skin (eg, salicylic acid, benzoyl peroxide, astringents)
Documented hypersensitivity; excess irritation; pregnancy
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
May cause burning or stinging sensations; discontinue if excessive irritation occurs; rinse thoroughly if contact with eyes, eyelids, or mouth; may cause severe irritation in eczematous skin; photosensitivity may occur
Vitamins
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)
Topical preparation containing vitamin D-3. Indicated for psoriasis. Seems to normalize maturation of epidermal cells.
Adult
Apply to rash bid
Pediatric
Apply as in adults
None reported
Documented hypersensitivity; hypercalcemia; vitamin D toxicity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Rarely can lead to elevated serum calcium level; discontinue treatment if skin becomes irritated; discontinue if serum calcium level is increased outside reference range
Moisturizers
This agent normalizes skin function.
Lactic acid (Lac Hydrin, AmLactin)
Topical medication used to treat dry skin. Relieves itching and aids in healing skin in mild eczemas and dermatoses, itching skin, minor wounds, and minor skin irritations. Found in a variety of topical emollient lotions.
Adult
Apply 1-3 times/d
Pediatric
Apply as in adults
None reported
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May cause stinging and burning at the site of application
Corticosteroids
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 (CortaGel, Cortaid, Dermacort)
Adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability. Can be a first-line treatment in this condition but can cause striae and skin thinning when used in axillary or groin areas.
Adult
Apply qd/bid
Pediatric
Not established
None reported
Documented hypersensitivity; viral, fungal, and bacterial skin infections
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Prolonged use, applying over large surface areas, applying potent steroids, and using occlusive dressings may increase systemic absorption of corticosteroids and may cause Cushing syndrome, reversible HPA-axis suppression, hyperglycemia, and glycosuria; use with caution in axillary and groin areas (can cause striae and skin thinning)
More on Granular Parakeratosis |
| Overview: Granular Parakeratosis |
| Differential Diagnoses & Workup: Granular Parakeratosis |
 Treatment & Medication: Granular Parakeratosis |
| Follow-up: Granular Parakeratosis |
| References |
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References
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Further Reading
Keywords
axillary granular parakeratosis, intertriginous parakeratosis, AGP, GP
