Parakeratosis is a cornification disorder of the skin, which is usually associated with skin diseases such as psoriasis, eczema or Bowen’s disease. The primary cause of parakeratosis can be an acceleration of the cornification process or a disruption in keratinocyte maturation. Treatment depends on the primary cause and any additional skin conditions present.
What is parakeratosis?
During cornification or keratinization, epithelial cells transform into horn-forming keratinocytes and become horny cells, so-called corneocytes. The keratinocytes, or horn-forming cells, are cells of the epidermis or cuticle that make up 90 percent of this layer of skin. The cell type is capable of producing keratin and thus differentiates during cornification. See ezhoushan for What does DNA Stand for.
Physiologically, keratinization processes take place within the epidermis and can also occur in various mucous membranes. The cornification increases the mechanical stability of the skin surfaces. The cornification process can be disturbed by various diseases. One of them is parakeratosis.
This form of dyskeratosis is characterized by nuclei or nucleus fragments remaining in the stratum corneum. In many cases, the stratum corneum thickens at the same time. This phenomenon is also known as parakeratotic hyperkeratosis. If parakeratosis and increased cornification occur together in the sense of hyperkeratosis, we are talking about hyperparakeratosis.
Parakeratosis can have different causes. In addition to an accelerated course of the cornification processes, a maturation disorder of the keratinocytes can be responsible for the phenomenon. Both phenomena can be traced back to hormonal connections.
Typically, parakeratosis in humans is associated with diseases such as psoriasis, eczema or Bowen’s disease. The skin changes in Bowen’s disease are often related to exposure to sunlight, chemicals such as arsenic, or certain viruses such as HPV. Men are more likely to be affected by the phenomenon than women.
A multifactorial genesis is assumed for psoriasis. In addition to genetic dispositions, immunological malfunctions are discussed in this context. In this context, the immunological malfunction corresponds to an autoimmune reaction in which the immune system attacks the body’s own tissue.
The trigger for immunological programming errors has not yet been conclusively clarified for any autoimmune disease. For example, previous infections are discussed.
Symptoms, Ailments & Signs
Patients with parakeratosis suffer from a cornification disorder in which cell nucleus residues remain in the cornea. An additional thickening of the affected skin layers is often observed. Symptoms accompanying parakeratosis are often diseases such as psoriasis.
Psoriasis typically manifests itself in the form of monomorphic, reddish, mostly round and island-shaped foci with sharp borders and a slight elevation. Instead of psoriasis, parakeratosis can also be associated with the skin changes of Bowen’s disease. Bowen’s disease appears on the skin in the form of isolated and irregularly shaped skin lesions with sharp borders.
The lesions appear broad and have a red, scaly appearance. The size of the lesions varies from a few millimeters to decimeters. Unlike psoriasis, Bowen’s disease usually has only one focus. In addition, the combination of parakeratosis and eczema is common.
Eczema is an inflammatory lesion with a non-infectious origin that occurs together with skin reddening, blistering and weeping and crusting or scaly areas. In addition to psoriasis, eczema and Bowen’s disease, parakeratosis can also cause painful areas and dry skin.
Diagnosis & course of disease
The diagnosis of parakeratosis is made by the dermatologist. In most cases, the visual diagnostic impression after the anamnesis is sufficient for the diagnosis. Magnification instruments may be used to better identify the remaining cell nuclei. The detection of the typically occurring cell nuclei within the cornea is sufficient to confirm the diagnosis.
The prognosis for patients with parakeratosis depends on the primary cause. The nature of the accompanying symptoms can also play a decisive role in the prognosis. Psoriasis, for example, has so far been considered an incurable skin disease.
Due to the parakeratosis, the patient develops various diseases and complaints on the skin. As a rule, these have a very negative effect on the aesthetics and thus also on the quality of life of the person concerned and limit them. In most cases, this leads to psoriasis and thus to a cornification disorder.
Many of those affected feel uncomfortable with the symptoms or are ashamed of them, which can lead to significantly reduced self-esteem or inferiority complexes. Psychological complaints and depression can also occur and are intensified above all by bullying or teasing. The skin is also red and itchy. Constant scratching can also cause scars or bleeding on the skin. The skin itself is dry and scaly in parakeratosis.
The treatment of parakeratosis is usually not associated with complications. With the help of various medications and therapies, the symptoms can be limited relatively well. The patient’s life expectancy is also not reduced due to the disease. At times, sufferers may need light therapy to completely curb the disease.
When should you go to the doctor?
Special features and abnormalities of the complexion should be examined and clarified by a doctor. If the affected person suffers from thickening of the skin or the formation of a cornea, a doctor’s visit is advisable. If the irregularities in the skin cannot be improved by taking care measures yourself, it is advisable to seek medical help. Drugstores and pharmacies have a variety of skin care products that you can try.
If the symptoms persist for a long time or if they spread continuously over the body, an intensive examination of the skin is recommended. If changes to the usual skin appearance occur, a doctor’s consultation is necessary. Inflammation on the body or the formation of pus are considered alarming. If the affected person cannot guarantee sterile wound care, a doctor should be consulted. In severe cases, there is a risk of blood poisoning and there is a potential danger to life. Discolouration of the skin, redness and the formation of eczema must be examined by a specialist.
If blisters develop or skin peels, medical advice should be sought. Any pain, general discomfort or emotional problems should be discussed with a doctor. If there is a withdrawal from social life, mood swings or depressive behavior, help is needed.
Treatment & Therapy
A causal therapy for parakeratosis is only conceivable under certain circumstances. As a rule, the cornification processes cannot be sufficiently slowed down. Maturation disorders of the keratinocytes, on the other hand, can be influenced to a certain extent.
For symptomatic therapy against skin dryness, primarily conservative drug therapy options are available. In most cases, these are ointment treatments that contain the necessary active ingredients. If the parakeratosis occurs as part of another skin disease, further therapy must be carried out.
The treatment of eczema is carried out externally with ointments, the consistency of which is chosen depending on the condition of the skin. Acute weeping eczema requires treatment with relatively watery ointments. If there are crusts or scales, a greasy ointment base should be chosen. The ointments may also be used in the form of an envelope.
All inflammatory reactions of the skin are suppressed with glucocorticoid envelopes. Skin-irritating substances must be avoided by patients with parakeratosis in the near future. If psoriasis is also present, the treatment approaches range from a change in diet to electrotherapy, bathing and light therapy to medicinal approaches such as corticosteroids.
If Bowen’s disease also occurs, either an excision of the affected skin areas or photodynamic therapy takes place. During the excision, a subsequent analysis of the cutting edge must be carried out, which may provide the impetus for a subsequent excision.
Outlook & Forecast
Parakeratosis offers a relatively good prognosis. Skin cornification can be treated with various medications and forms of therapy. Treating the causes is often enough to contain the parakeratosis. During the disease phase, parakeratosis limits quality of life and well-being. Typical symptoms such as itching, dandruff or mental stress should disappear after the treatment is complete. Life expectancy is generally not limited by parakeratosis because it is not a fatal disease. However, inflammation or other medical complications can develop if the affected areas are scratched or handled improperly. In general, however, parakeratosis patients have a chance of recovery.
The prognosis is worse if parakeratosis occurs in connection with hyperkeratosis. Such hyperparakeratosis can cause nail changes, wounds and other medical complications that are associated with severe symptoms. The use of aggressive drugs such as ointments containing a lot of urea is necessary, which can result in further health restrictions.
The responsible dermatologist makes the prognosis with regard to, among other things, the severity of the disease and the general condition of the patient. In the case of severe comorbidities, the other doctors must be involved in the prognosis.
So far, there is no promising way to prevent parakeratosis.
In most cases, direct follow-up measures for parakeratosis are severely limited. The further course of this disease depends very much on the time of diagnosis and also on the severity of the symptoms, so that a general prediction is usually not possible. For this reason, the person affected should consult a doctor at the first symptoms and signs of the disease in order to prevent the occurrence of further complications and complaints.
As a rule, self-healing cannot occur in the case of parakeratosis. Most of those affected depend on the use of various creams or ointments. It is always important to ensure the correct dosage with regular use. Regular checks by a doctor are also very important, and the support of friends and family is also very important.
This can prevent or alleviate depression or other mental upsets. Complete healing cannot always be achieved, so contact with other people affected by parakeratosis can also be very useful. This results in an exchange of information, which can make everyday life easier for those affected.
You can do that yourself
A parakeratosis does not necessarily require treatment. Foods with zinc and iron are recommended for severe symptoms. The minerals improve the complexion and help to reduce keratinization disorders. The affected areas should be carefully cared for and, if necessary, treated with a cleansing ointment. The care products used contain minerals and anti-inflammatory substances, which alleviate the acute symptoms and lead to a reduction in cornification in the long term.
The family doctor can prescribe the appropriate preparations and give further tips for parakeratosis treatment. It is usually sufficient to protect the affected areas. In order to avoid further calluses on the feet, shoes that are too tight should not be worn. If the parakeratosis occurs in another part of the body, any triggers or intensifiers of the condition must be identified. Clothing that is too tight often contributes to calluses.
If the parakeratosis rapidly increases, the doctor must be involved. It is possible that the disturbed keratinization is based on a serious illness that needs to be examined and treated. A removal of the cornifications with a callus plane should only be done in consultation with the dermatologist.