Clinical features, histology, and treatment outcomes of granular parakeratosis: a systematic review

Int J Dermatol. 2022 Aug;61(8):973-978. doi: 10.1111/ijd.16107. Epub 2022 Jan 30.


Background: Granular parakeratosis is a rare disorder characterized by erythematous-brown hyperkeratotic papules and erythematous patches with scaling, occurring predominantly in the flexures and sites of occlusion. While the exact underlying pathogenesis remains unknown, there has been a wide variety of precipitating factors and treatment options reported in the literature.

Objective: We systematically reviewed and identified precipitants of granular parakeratosis, as well as its clinical and histologic features and treatment outcomes.

Method: A comprehensive literature search was conducted using MEDLINE and Embase in March 2021.

Results: A total of 60 studies with 129 patients were included for analysis. An inciting factor was identified in 53.4%, the most common being topical agents including zinc oxide (17.1%), deodorant/antiperspirant (15.5%), and those containing benzalkonium chloride (7.0%). The majority presented with bilateral (68.2%) eruption of hyperkeratotic papules or erythematous patches and plaques, most frequently involving the axilla (56.5%). The prevailing histologic feature was retained keratohyalin granules within the stratum corneum in punch biopsy (97.2%) and curette (100%) specimens. Treatment options with reported success ranged from topical corticosteroids and systemic antibiotics to surgical interventions.

Conclusion: We provide a systematic review of reported precipitants, clinical features, and treatment options that clinicians should consider when granular parakeratosis is considered.

Publication types

  • Systematic Review

MeSH terms

  • Dermatologic Agents* / therapeutic use
  • Humans
  • Keratosis* / complications
  • Parakeratosis* / drug therapy
  • Skin / pathology
  • Treatment Outcome


  • Dermatologic Agents

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