Parakeratosis: Causes and Symptoms

The term parakeratosis indicates a subversion of the normal cellular differentiation process, in which the superficial layers of the skin and mucous membranes take on a thickened, scaly, whitish and keratinized appearance.
This thickening is mostly caused by chronic phenomena both of an irritative and inflammatory type, resulting from the exposure of infectious, mechanical and chemical stimuli.
This type of mechanism mainly affects the dermatological field , being a typical manifestation of psoriasis, dermatitis and chronic eczema, but also the gynecological field: as we will see, parakeratosisit is found in numerous conditions, in response to infections or irritative stimuli.
Parakeratosis is not a malignant lesion, in fact it does not indicate a neoplastic process, so if it appears in the report of a gynecological examination or a pap test in general it should not arouse particular fears, but instead the need to scrupulously perform all the tests according to the times indicated by the gynecologist.
Having defined the context within which the conditions of parakeratosis take on prominence, let’s investigate the conditions under which this subversion of cellular differentiation processes occurs more often.

What are the pathologies in which parakeratosis occurs
We have tried to rationalize all the conditions that involve the appearance of parakeratosis by reporting the main pathological manifestations for each.

Psoriasis
This pathology can cause strong psychological repercussions due to skin manifestations that often concern very exposed areas of the body, therefore any type of evaluation must be entrusted to the attention of a dermatology specialist.
Psoriasis is a multifactorial disease, therefore triggered by the establishment of several conditions, characterized by a cyclical pattern in which there are lesions of the skin that takes on a scaly, thickened and whitish appearance.
Two peaks of onset are identified, the first between 20 and 30 years of age with the worst course and a second peak which is established between 50 and 60 years with a less severe and more nuanced course.
Returning to the factors promoting the onset of the disease, a role of fundamental importance is due to mutations in the genes that regulate the cell cycle and often this disorder manifests itself more in subjects who are familiar with the disease, therefore parents or grandparents who have suffered from it. .
However, the genetic component is not the only one to explain the onset of the disease, in fact, since psoriasis occurs, other triggering events (called triggers) must concur:

• Stress: often underestimated, but perpetrated conditions of stress can cause alterations to damage the immune system;
• Infections: mainly caused by streptococcal bacteria, they can trigger auto-immune reactions, in which the immune system identifies skin antigens as foreign substances to attack. This phenomenon results in an eruptive psoriasis, with numerous pustules;
• Trauma: traumatic events can trigger a phenomenon that takes the name of Koebner, or reactive isomorphism, in which all the typical traits of a dermatosis appear in the site of the trauma, caused by an episode even rather mild as the sole gesture of scratching ( redness, itching, keratinization);
• Exposure to UVA and UVB rays: despite the recommendations, too often the danger of direct exposure to the sun is underestimated. In addition to the real danger of promoting the onset of a melanoma, the sun’s rays can also promote the onset of psoriasis;
• Bad habits: among these it is necessary to include smoking and alcohol;
• Hormonal changes: this is the case of pregnant or menopausal women;
• Drugs: the intake of some classes of drugs is also found to promote manifestations of psoriasis, in particular ACE inhibitors, beta blockers and immunostimulating drugs.

There are parts of the body most affected by psoriasis, located mostly in the body folds, and in particular: elbows, knees, auricle, buttock fold, but it is also very widespread in the scalp, hands, feet, region of the pubis and more rarely also affects the tongue.

What to do in these cases
As for the treatments they are mainly based on three action interventions:

• Topical therapies: that is, localized at the point of skin manifestations. This type of treatment is chosen when the disorder affects a limited area of ​​the body. Generally, cortisone drugs or calcitriol are administered;
• Systemic therapies: used when the manifestations are widespread and affect several areas of the body at the same time. The treatments are administered on the basis of the extent of the disease, and generally retinoids and cyclosporine, or monoclonal antibodies are used;
• Phototherapy: artificial sources are used that emit UVA and UVB rays specifically calibrated for the individual case.

In any case, it is recommended to follow only the instructions provided by a specialist in dermatology, the only one with the necessary knowledge to successfully treat a pathology as complex as psoriasis, and to be wary in any way of any suggestions regarding improbable remedies. natural provided on the pages of some forum.

Gynecological field
We have mentioned how the parakeratosis process assumes particular importance also in gynecology, in fact this alteration can occur in conjunction with disorders that affect the female reproductive system.
It should be noted, however, that parakeratosisit does not necessarily indicate a pathology or a concrete risk to a woman’s health but, nevertheless, it is a factor to be kept under control.
So let’s see in response to which phenomena a keratosis can be created in the gynecological field:

• Vulvar dermatitis: these are banal contact dermatitis, i.e. reactions triggered by contact with irritants or to which one is allergic, whether of a biological, chemical or physical nature. There are two forms of dermatitis, one acute and one chronic, but only the latter is involved in the process of hyperkeratosis.A continuous and constant stress determines the onset of inflammatory phenomena that result in a thickening of the skin ( parakeratosis), disappearance of the skin appendages (therefore of the hairs), desquamation, itching and skin that is gray-pink.The treatments are generally based on the removal of the factors triggering the problem, therefore of all those irritants responsible for the problem. On medical advice, topical corticosteroids or antihistamines (in case of allergic manifestations) can be taken.
• Lichen sclerus: condition similar to vulvar dermatitis, which strictly affects the skin (but not the mucous membranes) of the vulva and the perianal area. Manifestations include hyperkeratosis, then thickening of the skin, skin that takes on a pearly white appearance, itching, dryness and burning;
• Papillomavirus (HPV) infection: with this point a great chapter in gynecology openswhich often creates confusion. The Papilloma virus is transmitted by sexual contact through unprotected intercourse, and is a promoting factor for the onset of most cancers of gynecological interest (cervical cancer, vagina and vulva cancer), but also cancers of the oral cavity and oropharynx. It is essential to state that about 75% of the population in the course of life has come into contact with this virus, so it must be clear that testing positive for HPV is not an indication of cancer. As we have specified, the Papilloma virus is one of the factors promoting the development of cancer, but for a tumor to develop, more events and concomitant factors must be added, such as individual genetic predispositions, smoking,
  The sum of various contributing causes can take a variable period between 15 and 20 years before transforming into neoplasm, and it is for this reason that the introduction of specific screening tests (such as the well-known Pap test ) assumes a fundamental and decisive role. in the control of the development of forms of tumor. This test makes it possible to verify the presence of significant alterations, at intervals of time established on the basis of age and risk factors, through a small sample (biopsy) of the mucosa. The pap test allows to identify any alterations in early stages, thus guaranteeing excellent healing prospects.
  To date, a vaccine is available to be administered to girls between 9 and 12 years of age (but also to boys), therefore before they begin to have an active sex life and therefore before coming into contact with the virus. Vaccination significantly reduces the risk of developing cervical cancer. In any case, the administration of the vaccine is also possible for adult women already exposed to the virus, at this point not for therapeutic purposes, but for preventive purposes on the possible re-infection of the virus.

What to do in these cases
Parakeratosis in gynecology must be properly analyzed, diagnosed and treated by a specialist in gynecology. Therapeutic approaches differ depending on the type of pathology to be treated. In the case of dermatitis and Lichen, the therapeutic approach must also involve a specialist in dermatology as the manifestations mostly affect the areas of the skin and mucous membranes.
In the case of positive Papilloma virus it is advisable to undergo a Pap test annually in order to always keep under control the progression or not of the lesions.
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