Infantile granular parakeratosis: Case report
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Granular parakeratosis (GP) is a skin disease that manifests as erythematous or hyperpigmented papules that developed in the intertriginous area. The cause of the condition remains unclear, and the tendency of the lesions to affect the intertriginous areas suggests that physical factors can play a role in the development of the skin lesions.

It was hypothesized that GP develops in infants who are susceptible after being exposed to occlusion and moisture from the diaper and leads to defective maturation of the epidermis in the affected areas. Other triggering factors that were implicated include topical use of zinc oxide and frequent washing of the area with liquid soap. The author herein describes a case of GP affecting the diaper areas in a 14-month-old boy noted after starting to wash the diaper area with soap along with the topical use of zinc oxide.

A healthy 14-month-old boy had a 2-month history of recurrent, brown warty papules and plaques affecting the inguinal fold and the buttock. The lesions were asymptomatic. The lesion was first noted when the mother started to wash the area with soap twice daily, followed by applying zinc oxide cream. He was previously treated by topical miconazole cream twice daily for 2 weeks with no much improvement noted. His medical history is unremarkable, and there was no family history of cutaneous diseases.

Clinical examination of the area revealed symmetric multiple, coalescing brown papules, and linear plaques affecting the inguinal folds and the buttock. The diagnosis of GP was based on characteristic clinical features and was advised to stop washing the area with soap and refrain from using zinc oxide paste. The patient noted the disappearance of the lesions after 2 weeks from stopping the habit of washing with soap and started cleaning the area with water and the discontinuation of zinc oxide paste.

Treatment options of this condition are limited and included the use of topical tacrolimus, pimecrolimus, topical steroids with variable results, and topical keratolytic agents such as salicylic acid at concentration 3%–5% with good efficacy in eliminating the lesions. The spontaneous resolution was reported in some patients after the cessation of topical zinc oxide.