Axillary granular parakeratosis.

Abstract

Axillary granular parakeratosis is an alteration of keratin characterized by a thick parakeratotic horny layer with abundant intracellular keratohyalin granules. It was first described in 1991 and since then 32 cases have been reported from USA, Europe and Australia. Lesions may affect intertriginous areas other than the axilla. The disease has apparently not been previously described in Latin America. Three overweight Colombian women were diagnosed with axillary granular parakeratosis. They presented encrusted, hyperkeratotic, hyperpigmented and pruriginous papules and plaques which affected both axillae in two women and only one in the other. Lesions had persisted for two and four months in two patients and for one year in the third. Clinical diagnoses were benign familiar pemphigus and tinea nigra. Skin biopsies showed a thick parakeratotic basophilic horny layer. Electron microscopy demonstrated a high content of keratohyalin granules. No Langerhans cells were demonstrated in the lesions using IHC for S-100 protein. No fungi were seen with the PAS stain. Infundibula showed thick horny plugs with changes similar to those seen in the epidermis. Dermal tissue showed few perivascular lymphocytes. These findings suggest that the disease has an irritative pathogenesis. Clinical histories indicated that the three women were overweight and used several types of antiperspirants. These factors plus local irritation and humidity apparently triggered the keratinization response.