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Year : 2014  |  Volume : 15  |  Issue : 1  |  Page : 12-15

Parakeratosis pustulosa: A diagnostic conundrum

Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda), Himachal Pradesh, India

Correspondence Address:
Vikram K Mahajan
Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda) - 176 001, Himachal Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2319-7250.131828

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Parakeratosis pustulosa (PP) is not so rare an entity and remains under reported in the literature perhaps for the simple reason of mistaken identity. The literature on PP was reviewed for epidemiology, etiology, clinicopathologic features, differential diagnosis, clinical course, and the therapeutic measures described. A Medline search (PubMed, Google, IndMed) carried out on 30 December 2012 revealed only 10 reports under the heading "parakeratosis pustulosa"; three were in languages other than English. This chronic dermatosis is characterized by erythemato-squamous lesions affecting the periungual skin/nail unit in children aged ≤5 years, mostly females. Nails show pitting and cross-ridging of one or more digits especially of the fingers. Its etiology remains obscure, and onychomycosis, psoriasis or pustular psoriasis, and atopic or contact dermatitis affecting the nail are important differentials. Acrodermatitis continua of Hallopeau remains the most common misdiagnosis in these patients. Topical emollients remain the recommended treatment, while topical corticosteroids or tretinoin are needed for recalcitrant cases. Evaluation of this as a distinct entity having benign, self-limiting clinical course and good prognosis will save the patient from expensive therapy and unnecessary distress associated with other more mutilating pustular dermatoses affecting the nail unit.

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