Scaly erythematous eruptions of intertriginous locations.

Intertriginous or flexural eruptions are common presenting problems in clinical practice, raising several differential diagnoses. A clinico-histopathological correlation is important to establish a correct diagnosis when a clinical diagnosis cannot be ascertained. We here present a case of flaky erythematous eruptions in a female adult, with a final diagnosis of granular parakeratosis, involving nonflexural area mid-back (under bra cover) in addition to flexural zones of the groin, gluteal fold, inframammary fold and axilla. It seems that mechanism of pressure and friction as well as occlusion all play a part. Management with potent topical steroid and avoidance of inciting triggers offered resolution in 4 weeks in this case.

Granular parakeratosis secondary to benzalkonium chloride exposure from common household laundry rinse aids.

AIM: Granular parakeratosis (GP) is a benign dermatosis characterised by a rash at intertriginous sites. The pathogenesis is uncertain although it is proposed to be an irritant contact reaction with cases related to benzalkonium chloride (BAC) reported. Our experience is that patients often have delayed diagnosis. This study aims to review the clinical presentation and histopathological features of GP. METHODS: This study is a retrospective case series of adult and paediatric patients seen at dermatology clinics in Auckland, New Zealand. Information was collected on patient demographics, presentation, investigations and management. RESULTS: Thirteen cases (seven adults; six children) are included. The typical presentation of GP was erythematous or brown, scaly papules and plaques with desquamation in a predominantly flexural distribution. All patients reported recent exposure to BAC in laundry rinse solution. Nine biopsies were taken from four patients. Psoriasiform and eczematous findings were common on histopathology. The mainstay of treatment was cessation of BAC exposure. CONCLUSION: GP has a distinct clinical pattern although histopathological findings are varied. Clinicians should have a high index of suspicion for GP in patients presenting with erythematous flexural eruptions and seek a history of BAC exposure, especially in the context of the COVID-19 pandemic and increased antiseptic use.

Axillary Granular Parakeratosis.

We describe a case of an 85-year-old Caucasian female who presented to the dermatology clinic with pruritic, scaly hyperpigmented papules and plaques with surrounding erythema in the left axilla. Based on the history and physical examination, there was concern for possible varicella zoster infection, and the patient was started on valacyclovir 1000 mg three times daily for seven days. A shave biopsy was taken from the left axilla to confirm a diagnosis. Microscopic examination revealed compact hyperparakeratosis with keratohyalin granules throughout the parakeratotic stratum corneum as well as admixed eosinophils within the stratum corneum. The epidermis was acanthotic with irregular hyperplasia of the rete ridges. These microscopic findings supported a diagnosis of axillary granular parakeratosis, a benign skin condition caused by a defect in epidermal differentiation. Granular parakeratosis is seemingly rare but is felt to be an underreported condition. It is important for clinicians to be aware of the disease in order to correctly identify the lesions and reassure patients of its benign nature and provide appropriate treatment recommendations.

Caso de paraqueratosis pustulosa: entidad poco frecuente y síntoma de enfermedad inflamatoria del aparato ungueal en pacientes pediátricos / Case of pustular parakeratosis: a rare entity common and symptom of inflammatory disease of the nail apparatus in pediatric patients

La paraqueratosis pustulosa es una entidad poco descrita en la literatura y se define como un proceso inflamatorio cutáneo, ungueal y periungueal en el área distal de un dedo habitualmente pulgar o índice, frecuentemente en la infancia. Su evolución suele ser benigna y la respuesta a emolientes tópicos es favorable. A continuación, se presenta un caso de esta enfermedad con el objetivo de resaltar su consideración en patologías ungueales pediátricas.

Pustular parakeratosis is an entity scantly described in literature. It has been described as a skin, nail, and periungual inflammatory process in the distal area of a finger, usually the thumb or index finger, frequently in childhood. Its evolution is usually benign and management is favorable with topical emollients. A clinical case is presented, to raise awareness of this entity in pediatric nail pathologies.

Erupción dermatomiositis-like en una paciente tratada con hidroxiurea / Dermatomyositis-like Eruption in a Woman Treated With Hydroxyurea

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Lichen planus-like keratosis: clinicopathological evaluation of 1366 cases.

BACKGROUND: Lichen planus-like keratosis (LPLK) is a frequent skin lesion usually biopsied to rule out basal cell carcinoma (BCC). Because of overlapping histopathological characteristics, LPLK is frequently muddled with lichen planus (LP), lichenoid actinic keratosis (LAK), and lupus erythematosus (LE). OBJECTIVE: To investigate the clinical and histopathological characteristics of LPLK. METHODS: A clinicopathologic review was performed of all LPLK cases (1366) signed in one calendar year in a busy academic practice. RESULTS: LPLK occurs mostly as a single lesion (97%) with the chest (41.4%) being the most common site. It is almost equally present in women and men (51.5%-48.5%). The most common clinical concern (65%) is basal cell carcinoma. Parakeratosis, red blood extravasation, and presence of dermal eosinophils and plasma cells, usually not seen in lichen planus, are helpful signs to suggest LPLK but are seen only in a minority of cases. CONCLUSION: Clinicopathologic correlation is necessary to diagnose lichen planus-like keratosis, as the most consistent feature is a clinical history of a lesion/neoplastic process rather than an inflammatory process. There are histopathologic features that can help distinguish lichen planus-like keratosis from lichen planus; however, these features are nonspecific and lacking in almost half of the cases.

Paraqueratosis pustulosa / Parakeratosis pustulosa

La paraqueratosis pustulosa es una entidad poco frecuente, cuenta tan solo con una decena de publicaciones. Las lesiones se limitan a uno o dos dedos de las manos, y es más frecuente en niñas durante la primera infancia. Dado que, en ocasiones, su aparición puede simular el debut de otras enfermedades dermatológicas como psoriasis, es importante completar una adecuada anamnesis dirigida a descartar estos antecedentes familiares, así como otros diagnósticos diferenciales como acrodermatitis continua de Hallopeau, micosis y dermatitis atópica o de contacto. La evolución suele ser favorable, precisando tratamientos tópicos con emolientes y, en casos refractarios, con corticoides tópicos. Se presenta un caso de esta entidad

Pustular parakeratosis is a rare entity with few cases published nowadays. The lesions are limited to one or two fingers of the hands, being more frequent in girls during early childhood. Given that its appearance can sometimes simulate the first stages of others dermatological diseases such as psoriasis, it is important to complete an adequate anamnesis with the family history, as well as ruling out other differential diagnoses such as Hallopeau's continuous acrodermatitis, mycosis, atopic dermatitis or contact dermatitis. The evolution is usually favourable, requiring topical treatments with emollients and, in refractory cases, topical corticosteroids. We present a case of this entity

Épulis del recién nacido / Newborn epulis

Niña de siete días de edad, cuya madre refiere que "nació con un bulto en la boca". Durante la lactancia materna perdía leche por el labio superior en poca cantidad. En la inspección clínica se encontraron tres lóbulos (uno palatino y dos vestibulares) en el rodete maxilar superior del lado izquierdo. Diagnóstico presuntivo: épulis congénito del recién nacido. Después de 27 días del diagnóstico regresó a consulta. No presentaba a la inspección el lóbulo palatino. Se realizó cirugía convencional para el caso, extirpando de manera total la tumoración. Se envió la pieza quirúrgica a patología resultando como diagnóstico definitivo: épulis congénito del recién nacido (AU)

A seven-day-old girl whose mother says she was "born with a lump in her mouth". During breastfeeding some milk came out from her upper lip in small quantities. At the clinical examination, three lobes (one palatine and two vestibular) were found in the left maxilla. Suspected diagnosis: congenital epulis of the newborn. After 27 days, when she returned to consultation, it was observed that the palatine lobule had disappeared spontaneously. Conventional surgery was performed for the case, removing the tumor completely. The surgical part was sent to pathology resulting in definitive diagnosis: congenital epulis of the newborn (AU)

Paraqueratosis granular, una rara entidad. A propósito de un caso / Granular parakeratosis: a rare entity. A case report

La paraqueratosis granular axilar es una entidad poco frecuente debida a una alteración del proceso de queratinización, lo que produce un engrosamiento de la epidermis a expensas de la capa córnea. La etiología es desconocida, implicándose, entre otros, a agentes irritantes. Presentamos un caso de paraqueratosis granular axilar en una mujer de 31 años, asociada a un posible factor irritante, el desodorante, localizada en ambas axilas, sin mejoría ante el tratamiento farmacológico (corticoides y antifúngico) y con remisión completa tras la retirada del mismo (AU)

Granular parakeratosis is a rare entity that results from a disorder of keratinization, producing an epidermal thickening of the stratum corneum. The etiology is unknown although some factors, such as irritating agents, have been implicated. We present a case of granular parakeratosis associated with an irritating agent (a deodorant) in both axillae of a 31-year-old woman. She did not respond to therapy with corticosteroid and antifungal agents but the GP resolved spontaneously when use of the deodorant was stopped (AU)

Submammary Granular Parakeratosis Treated With Mastopexy.

Granular parakeratosis, originally named axillary granular parakeratosis, is an uncommon disease with an unclear etiology. It is thought to result from defective processing of profillagrin to fillagrin, causing retention of keratohyaline granules in the epidermis. A myriad of causative factors has been proposed, including friction, moisture, heat, and contact irritants such as deodorants. We present a case in the inframammary area that resolved with mastopexy, further supporting the role of friction, moisture, and heat. Furthermore, we present electron microscopic evidence demonstrating non-degraded keratohyaline granules upon epidermal maturation. This entity, we believe, is reactive and represents a protective response of the body to moisture and heat.

J Drugs Dermatol. 2017;16(8):810-812.