Granular parakeratosis caused by exposure to benzalkonium chloride laundry rinse: Four paediatric cases

Abstract

Benzalkonium chloride is a quaternary ammonium compound that is widely used as a skin disinfectant and sanitising agent in a number of household cleaning and personal hygiene products. Benzalkonium chloride is a well-known skin irritant. It has been postulated that exposure to benzalkonium chloride may induce the pathological cascade of granular parakeratosis in genetically susceptible individuals through disruption of epidermal lipids. Granular parakeratosis is a rare benign acquired disorder of keratinisation with a predilection for middleaged women. Herein, we present a case series of four children who developed granular parakeratosis after exposure to benzalkonium chloride in laundry rinse aids. Four children (age range 4 months to 3 years) presented with well-demarcated erythematous to brown hyperkeratotic annular eruptions primarily affecting intertriginous regions such as the axilla and groin, followed by desquamation. All patients had a history of exposure to laundry rinse aids containing the active ingredient benzalkonium chloride. A diagnosis of granular parakeratosis induced by benzalkonium chloride exposure was made after thorough clinical assessment. The eruptions resolved over 2- 4 weeks after cessation of benzalkonium chloride exposure. This case series highlights the importance of timely diagnosis which can be achieved by thorough clinical assessment and knowledge of the possible precipitants of granular parakeratosis. We recommend that exposure to exogenous agents such as benzalkonium chloride be considered by dermatologists in all paediatric patients presenting with granular parakeratosis.L6381499402022-06-08 <br />