Parakeratosis is a benign skin condition characterized by dry, scaly skin. There are a variety of potential causes and treatment approaches that can be discussed with a dermatologist. Evaluation by a skin professional is usually recommended to distinguish between parakeratosis and other skin diseases that may require different treatments. This condition is not contagious and while there can be hereditary components, it is not necessarily passed from parents to children.
In healthy skin, the upper layer of the skin, known as the stratum corneum, consists of dead cells that lie on each other like scales. The cells, known as horn cells, lack nuclei and are high in keratin, a protein that helps the skin retain moisture. Moisture retention keeps the skin flexible and strong, in addition to providing protection to the underlying tissues in the body. Over time, the dead cells are sloughed away and replaced with new cells that develop in the underlayers of skin. This constant cycle of renewal keeps the skin in good condition.
People with parakeratosis have horn cells that have retained their nuclei and are not completely keratinized. As a result, their skin becomes dry and the body loses moisture. Over time, dry scales develop and these can turn into deep cracks and fissures. Lesions in the skin can appear and sometimes the skin oozes and becomes red, inflamed, tender, and very painful. Typically, the layers of dry scales flake off very easily.
This skin disease has been linked with heavy use of topical preparations such as deodorant, makeup, and other substances that are applied directly to the skin. It can also occur in response to environmental exposures. In other cases, there may be no clear cause for the development of the scaly skin. A dermatologist can take a scraping to examine under a microscope to confirm parakeratosis and to rule out any other possible skin diseases.
Treatments can include dry brushing to remove the scales, along with the use of moisturizers to protect the skin. Topical anti-inflammatory creams can be applied to ease the redness and tenderness, and prescription intensive moisturizers may be recommended for patients with severe cracking and scaling. Patients may also be advised to make lifestyle changes, such as not applying certain materials directly to their skin and changing their diets to promote growth of healthy skin. Long term management of parakeratosis includes careful monitoring to catch the early signs of infection and inflammation in areas where the skin is dry and cracked.