LAUSR

[...]of the variety and nonspecific nature of clinical presentations that can be seen, diagnosis often relies on the pathognomonic histopathologic findings of granular parakeratosis. In granular parakeratosis, there is an alteration of keratinocyte maturation from the stratum granulosum to the stratum corneum, resulting in retention hyperkeratosis.1 This is thought to be caused by a defect in the processing of profilaggrin to filaggrin, leading to retention of keratohyalin granules, elevation of stratum corneum pH and ultimately increased adhesion and defective barrier function.1'5 This process is likely exacerbated by mechanical and chemical irritation, along with occlusive environments.6 It is now speculated that granular parakeratosis may be more of a reactive pattern in response to various stimuli than a distinct clinical disease.1 In recent years, there has been a greater recognition of the association between granular parakeratosis and chemical irritants found in antiseptic products, especially laundry rinse aids and detergents containing BAC.5'6 ANSWER 5 Treatments including topical and systemic corticosteroids, retinoids, vitamin D analogues, keratolytics and antifungal agents all have variable efficacy.6 Oral antibiotics such as amoxicillin-clavulanic acid may have some benefit.7 General skin cares, including emollients, are recommended. [...]these treatments are of limited value if contact with the causative agent is ongoing. [...]withdrawal of BAC-containing products is the mainstay of treatment.6 All clothing and linen must be washed in hot water;it can take multiple hot wash cycles to eliminate the irritant.