Granular Parakeratosis

Patient Information: Granular Parakeratosis Due to Benzalkonium Chloride

What is Granular Parakeratosis?

Granular parakeratosis is a skin condition characterised by the abnormal accumulation of granules in the outer layer of the skin (epidermis), leading to gritty or sandpaper-like patches on the skin’s surface. When granular parakeratosis is caused by exposure to benzalkonium chloride, a common preservative found in various personal care products, laundry detergents, laundry cleaners, it is known as granular parakeratosis due to benzalkonium chloride.

Causes of Granular Parakeratosis Due to Benzalkonium Chloride:

Benzalkonium chloride is a quaternary ammonium compound commonly used as a preservative in skincare products, such as cleansers, hand sanitisers, disinfectants, and eye drops. When applied to the skin in high concentrations or over prolonged periods, benzalkonium chloride can disrupt the normal skin barrier function and lead to the development of granular parakeratosis.

Symptoms of Granular Parakeratosis Due to Benzalkonium Chloride:

1. Gritty or Sandpaper-like Texture: Affected areas of the skin may feel rough, gritty, or sandpaper-like to the touch due to the abnormal accumulation of granules in the epidermis.
2. Redness and Irritation: The skin may appear red, inflamed, or irritated, particularly in areas of frequent exposure to benzalkonium chloride-containing products.
3. Itching or Discomfort: Some individuals may experience itching, burning, or discomfort in the affected areas, especially if the skin becomes irritated or inflamed.

Treatment Options for Granular Parakeratosis Due to Benzalkonium Chloride:

1. Discontinuation of Benzalkonium Chloride Exposure: The primary treatment for granular parakeratosis due to benzalkonium chloride is to identify and discontinue the use of products containing benzalkonium chloride. Your dermatologist may recommend switching to alternative skincare products that do not contain this preservative.
   If you have been washing clothes in benzalkonium chloride containing detergent or using laundry cleaner. Wash your machine with plain water on hot for multiple cycles before use. Wear clothes that have not been washed with benzalkonium chloride containing detergent.
2. Laundry: Benzalkonium chloride binds to clothing fibres and begins to leech onto the skin when warm and damp in areas such as the groin and arm pits. You will have to launder your clothes in hot water for multiple cycles to remove the benzalkonium chloride from the fabric before they are safe to wear.
   Use OMO sensitive laundry detergent.
3. Topical Corticosteroids: Apply as directed.
4. Emollients and Moisturizers: Regular use of emollients and moisturisers can help soothe dry, irritated skin and restore the skin barrier function. Choose products that are fragrance-free, hypoallergenic, and suitable for sensitive skin.
   Dermeeze Ointment or Epaderm Ointment
5. Antibiotics: Sometimes you will be prescribed an oral antibiotic. Take as directed.
6. Hygiene Measures: Practice good hygiene by using mild, non-irritating, soap free cleansers and avoiding excessive scrubbing or rubbing of the skin. Pat the skin dry gently after bathing or showering to minimise friction and irritation.
7. Avoidance of Other Irritants: In addition to benzalkonium chloride, avoid other potential irritants or allergens that may exacerbate symptoms of granular parakeratosis, such as harsh soaps, detergents, or abrasive skincare products.

Prevention:

To prevent granular parakeratosis due to benzalkonium chloride, consider the following measures:

1. Read Product Labels: Check the ingredient labels of skincare products, household cleaners, and other personal care items to identify and avoid products containing benzalkonium chloride.
2. Choose Benzalkonium Chloride-Free Products: Opt for alternative products that use different preservatives or are labeled as benzalkonium chloride-free.
3. Patch Testing: If you have a history of skin sensitivity or allergies, consider patch testing new skincare products before applying them to larger areas of the skin.

Conclusion:

Granular parakeratosis due to benzalkonium chloride is a skin condition characterized by the abnormal accumulation of granules in the epidermis, resulting in gritty or sandpaper-like patches on the skin’s surface. Treatment involves discontinuing exposure to benzalkonium chloride, using topical corticosteroids if necessary, and practicing good skincare hygiene. Prevention involves avoiding products containing benzalkonium chloride and opting for alternatives.