Granular Parakeratosis Workup

Author: Noah S Scheinfeld, MD, JD, FAAD; Chief Editor: Dirk M Elston, MD more...

Updated: Jul 18, 2011

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Laboratory Studies
Other Tests
Procedures
Histologic Findings
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References

Laboratory Studies

A potassium hydroxide preparation can be used to check for fungal infection.

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.^[23]Most investigators report a well-developed granular layer and a sparse lymphohistiocytic inflammatory infiltrate. The retained granular layer sometimes demonstrates focal vacuolization. Note the following:

In 2003, Resnik and DiLeonardo^[24]described a follicular granular parakeratosis that was a granular parakeratosis confined to the follicle.
In 2004, Resnik et al^[25]described dermatophyte-related granular parakeratosis.
Incidental granular parakeratosis has been associated with carcinomas,^[26]dermatomyositis,^[14]and molluscum contagiosum.^[15]
Resnik et al^[20]have noted the existence of a granular parakeratotic acanthoma.

Proceed to Treatment & Management

Contributor Information and Disclosures

Author

Noah S Scheinfeld, MD, JD, FAAD Assistant Clinical Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, and New York Eye and Ear Infirmary; Private Practice

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

Disclosure: Optigenex Consulting fee Independent contractor

Specialty Editor Board

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.

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside 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.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

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: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

References

Northcutt AD, Nelson DM, Tschen JA. Axillary granular parakeratosis. J Am Acad Dermatol. Apr 1991;24(4):541-4. [Medline].
Niesmann J, Bierhoff E, Dirschka T. [Hyperkeratotic pruritic papules in the submammary area. Diagnose: Granular parakeratosis]. J Dtsch Dermatol Ges. Aug 2010;8(8):631-3. [Medline].
Leclerc-Mercier S, Prost-Squarcioni C, Hamel-Teillac D, Fraitag S. A case of congenital granular parakeratosis. Am J Dermatopathol. Jul 2011;33(5):531-3. [Medline].
Martorell A, Sanmartín O, Hueso-Gabriel L, Guillén C. [Granular parakeratosis: disease or reactive response?]. Actas Dermosifiliogr. Jan 2011;102(1):72-4. [Medline].
Metze D, Rutten A. Granular parakeratosis - a unique acquired disorder of keratinization. J Cutan Pathol. Aug 1999;26(7):339-52. [Medline].
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].
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].
Braun-Falco M, Laaff H. Granular parakeratosis--a clinical-pathological correlation of 10 cases. J Dtsch Dermatol Ges. Apr 2009;7(4):340-4. [Medline].
Rodriguez G. [Axillary granular parakeratosis]. Biomedica. Dec 2002;22(4):519-23. [Medline].
Patrizi A, Neri I, Misciali C, Fanti PA. Granular parakeratosis: four paediatric cases. Br J Dermatol. Nov 2002;147(5):1003-6. [Medline].
Trowers AB, Assaf R, Jaworsky C. Granular parakeratosis in a child. Pediatr Dermatol. Mar-Apr 2002;19(2):146-7. [Medline].
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].
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].
Pock L, Hercogova J. Incidental granular parakeratosis associated with dermatomyositis. Am J Dermatopathol. Apr 2006;28(2):147-9. [Medline].
Pock L, Cermakova A, Zipfelova J, Hercogova J. Incidental granular parakeratosis associated with molluscum contagiosum. Am J Dermatopathol. Feb 2006;28(1):45-7. [Medline].
Reddy IS, Swarnalata G, Mody T. Intertriginous granular parakeratosis persisting for 20 years. Indian J Dermatol Venereol Leprol. Jul-Aug 2008;74(4):405-7. [Medline].
Ezra N, Karunasiri D, Chiu MW. Unilateral pruritic axillary rash: axillary granular parakeratosis. Arch Dermatol. Dec 2008;144(12):1651. [Medline].
Paradisi A, Sisto T, Annessi G. Groin granular parakeratosis. Eur J Dermatol. Mar-Apr 2010;20(2):242-3. [Medline].
Niesmann J, Bierhoff E, Dirschka T. [Hyperkeratotic pruritic papules in the submammary area. Diagnose: Granular parakeratosis]. J Dtsch Dermatol Ges. Aug 1 2010;8(8):631-3. [Medline].
Resnik KS, Kantor GR, DiLeonardo M. Granular parakeratotic acanthoma. Am J Dermatopathol. Oct 2005;27(5):393-6. [Medline].
Joshi R, Taneja A. Granular parakeratosis presenting with facial keratotic papules. Indian J Dermatol Venereol Leprol. Jan-Feb 2008;74(1):53-5. [Medline].
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].
Mehregan DA, Vandersteen P, Sikorski L, Mehregan DR. Axillary granular parakeratosis. J Am Acad Dermatol. Aug 1995;33(2 Pt 2):373-5. [Medline].
Resnik KS, DiLeonardo M. Follicular granular parakeratosis. Am J Dermatopathol. Oct 2003;25(5):428-9. [Medline].
Resnik KS, Kantor GR, DiLeonardo M. Dermatophyte-related granular parakeratosis. Am J Dermatopathol. Feb 2004;26(1):70-1. [Medline].
Resnik KS, DiLeonardo M. Incidental granular parakeratotic cornification in carcinomas. Am J Dermatopathol. Jun 2007;29(3):264-9. [Medline].
Brown SK, Heilman ER. Granular parakeratosis: resolution with topical tretinoin. J Am Acad Dermatol. Nov 2002;47(5 Suppl):S279-80. [Medline].
Compton AK, Jackson JM. Isotretinoin as a treatment for axillary granular parakeratosis. Cutis. Jul 2007;80(1):55-6. [Medline].
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].
Ravitskiy L, Heymann WR. Botulinum toxin-induced resolution of axillary granular parakeratosis. Skinmed. Mar-Apr 2005;4(2):118-20. [Medline].
Samrao A, Reis M, Niedt G, Rudikoff D. Granular parakeratosis: response to calcipotriene and brief review of current therapeutic options. Skinmed. Nov-Dec 2010;8(6):357-9. [Medline].

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.

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