Hyperkeratotic flexural erythema (more commonly known as granular parakeratosis) with use of laundry sanitizers containing benzalkonium chloride.
Journal
Clinical and experimental dermatology
ISSN: 1365-2230
Titre abrégé: Clin Exp Dermatol
Pays: England
ID NLM: 7606847
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
accepted:
27
07
2022
pubmed:
28
9
2022
medline:
30
11
2022
entrez:
27
9
2022
Statut:
ppublish
Résumé
Hyperkeratotic flexural erythema (HKFE), also known as granular parakeratosis, is a scaly, erythematous or brown eruption, which usually occurs in the intertriginous and flexural areas. It has been linked to the use of benzalkonium chloride (BAK). To review the clinical presentation of patients diagnosed with HKFE who had been exposed to laundry sanitizer containing BAK, and the therapies trialled to treat these patients. This was a retrospective cases series of 45 patients seen by dermatologists in Victoria, Australia. Information was collected on clinical presentation, investigation and management. The patients varied in age from 18 months to 89 years. The rash typically presented as a symmetrical erythema with characteristic multilayered brownish epidermal scaling. The most common location of the rash was the inguinal/anogenital area (32 of 45 patients; 71.1%) and there was a female predominance. Regarding treatment, topical corticosteroids were frequently prescribed and antibiotics were trialled in 11 patients; however, the condition resolved spontaneously over time in all patients with use of emollients, along with cleaning of the washing machine by running an empty wash, and repeated washing or sometimes disposal of BAK-contaminated clothing. This large case series highlighted the characteristic clinical presentation of HKFE in the setting of BAK used in laundry sanitizer, demonstrating a potential causal link. Further studies are required to evaluate the role of the skin microbiome.
Sections du résumé
BACKGROUND
BACKGROUND
Hyperkeratotic flexural erythema (HKFE), also known as granular parakeratosis, is a scaly, erythematous or brown eruption, which usually occurs in the intertriginous and flexural areas. It has been linked to the use of benzalkonium chloride (BAK).
AIM
OBJECTIVE
To review the clinical presentation of patients diagnosed with HKFE who had been exposed to laundry sanitizer containing BAK, and the therapies trialled to treat these patients.
METHODS
METHODS
This was a retrospective cases series of 45 patients seen by dermatologists in Victoria, Australia. Information was collected on clinical presentation, investigation and management.
RESULTS
RESULTS
The patients varied in age from 18 months to 89 years. The rash typically presented as a symmetrical erythema with characteristic multilayered brownish epidermal scaling. The most common location of the rash was the inguinal/anogenital area (32 of 45 patients; 71.1%) and there was a female predominance. Regarding treatment, topical corticosteroids were frequently prescribed and antibiotics were trialled in 11 patients; however, the condition resolved spontaneously over time in all patients with use of emollients, along with cleaning of the washing machine by running an empty wash, and repeated washing or sometimes disposal of BAK-contaminated clothing.
CONCLUSION
CONCLUSIONS
This large case series highlighted the characteristic clinical presentation of HKFE in the setting of BAK used in laundry sanitizer, demonstrating a potential causal link. Further studies are required to evaluate the role of the skin microbiome.
Substances chimiques
Benzalkonium Compounds
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2196-2200Informations de copyright
© 2022 British Association of Dermatologists.
Références
Northcutt AD, Nelson DM, Tschen JA. Axillary granular parakeratosis. J Am Acad Dermatol 1991; 24: 541-4.
Metze D, Rütten A. Granular parakeratosis - a unique acquired disorder of keratinization. J Cutan Pathol 1999; 26: 339-52.
Robinson AJ, Foster RS, Halbert AR et al. Granular parakeratosis induced by benzalkonium chloride exposure from laundry rinse aids. Australas J Dermatol 2017; 58: e138-40.
Kumarasinghe SPW, Chandran V, Raby E, Wood B. Hyperkeratotic flexural erythema responding to amoxicillin-clavulanic acid therapy: report of four cases. Australas J Dermatol 2019; 60: 311-14.
Tian CJ, Purvis D, Cheng HS. Granular parakeratosis secondary to benzalkonium chloride exposure from common household laundry rinse aids. N Z Med J 2021; 134: 128-42.
Ding CY, Liu H, Khachemoune A. Granular parakeratosis: a comprehensive review and a critical reappraisal. Am J Clin Dermatol 2015; 16: 495-500.
Shen S, Pham CT, Ryan A, Bruce F. Granular parakeratosis in an adult female secondary to exposure to benzalkonium chloride laundry rinse. Australas J Dermatol 2019; 60: 254-6.
Kampf G. Biocidal agents used for disinfection can enhance antibiotic resistance in Gram-negative species. Antibiotics (Basel) 2018; 7: 110.
Kim M, Weigand MR, Oh S et al. Widely used benzalkonium chloride disinfectants can promote antibiotic resistance. Appl Environ Microbiol 2018; 84: 1-37.
Honda R, Toshida H, Suto C et al. Effect of long-term treatment with eyedrops for glaucoma on conjunctival bacterial flora. Infect Drug Resist 2011; 4: 191-6.
Abney SE, Ijaz MK, McKinney J, Gerba CP. Laundry hygiene and odor control: state of the science. Appl Environ Microbiol 2021; 87: e0300220.
Pradhan S, Madke B, Kabra P, Singh AL. Anti-inflammatory and immunomodulatory effects of antibiotics and their use in dermatology. Indian J Dermatol 2016; 61: 469-81.