Axillary intertriginous granular parakeratosis responsive to topical calcipotriene and ammonium lactate

Abstract

A 70‐year‐old white man presented to our clinic with a 6–8‐month history of a pruritic, occasionally burning eruption in both axillae. He had been using the same deodorant for more than 1 year and denied any changes in laundry detergent, soaps, or shampoos. He also denied application of other topical products. On physical examination, there were slightly erythematous, lichenified plaques in both axillae, with more extensive involvement of the left side (Fig. 1). Histologic examination of a punch biopsy specimen from a left axillary plaque revealed hyperkeratosis with retention of nuclei and keratohyaline granules in the stratum corneum (Fig. 2). The stratum granulosum was slightly thickened, and the epidermis was mildly acanthotic. Patch tests of the patient's deodorant and shampoo were negative. The patient was advised to discontinue use of his deodorant. His right axilla was treated with topical calcipotriene, applied twice daily, and his left axilla was treated with topical 12% ammonium lactate, applied twice daily. One month later, the lesions in the right axilla had completely resolved. The left axilla was slightly improved, but still exhibited dusky erythematous plaques. After one additional month of treatment with ammonium lactate, the left axillary lesions completely resolved. A follow‐up examination 9 months later revealed no recurrence of the lesions in either axilla. 1 Erythematous, lichenified plaques in the axilla 2 Photomicrograph of biopsy specimen showing keratohyaline granules in the stratum corneum (hematoxylin and eosin, × 200)

Granular parakeratosis in a patient treated with liposomal doxorubicin for ovarian carcinoma

“…Topical corticosteroids, antiseptic soaps, calcipotriene, antibiotics, antifungals, and emollients have been tried with variable results. 1,2,[21][22][23] Tretinoin cream (0.025% applied daily for 5 days) showed some efficiency in one case. 18 Botulinum toxin and cryotherapy have also been tried.…”

Granular parakeratosis: Pathologic and clinical correlation of 18 cases of granular parakeratosis

“…Numerous reports have subsequently noted the existence of GP occurring on the groin, abdomen, and lumbosacra, mandating the removal of the body region qualifier, ''axillary,'' from the descriptor of this pathologic condition. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] GP can occur for patients of all ages and both sexes although it seems more common in women. It has been reported in whites and blacks.…”

Granular Parakeratosis: A Comprehensive Review and a Critical Reappraisal

“…Common topical treatments for GP include corticosteroids [30], antifungals [18], tretinoin [6,31], antimicrobials/antiseptic soaps, vitamin D analogs [14,[32][33][34][35], and ammonium lactate [33]. In vitro studies on both human and rat skin have shown that glucocorticoids regulate profilaggrin expression and accelerate its processing to filaggrin [36,37], which may in part explain the efficacy of corticosteroids in some cases.…”