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Granular parakeratosis of multiple intertriginous areas

A 60‐year‐old woman presented with a 4‐year history of a recurrent reddish‐brown macular eruption mainly involving the submammary and inguinal flexures and with transient involvement of the axillae. The eruption usually flared during winter and would settle spontaneously within a few months. At presentation, it had persisted longer than usual into the warmer weather and varied in clinical appearance over the time of observation, at times showing psoriasiform features and hyperkeratosis. Biopsy revealed features typical of granular parakeratosis. It was unresponsive to multiple topical and oral antifungal agents, oral antibiotic therapy, topical corticosteroids and emollients, but eventually resolved with a combination of 1% hydrocortisone cream and 1% clotrimazole cream to which the patient added a commercial topical vitamin E preparation.