JH Yang, et al Fig. 1. (A) Photograph of the patient at the first visit to our clinic in August, showing multiple tiny blackish verrucous papules on the neck. (B) Photograph at the follow-up visit in October, showing disappearance of cutaneous lesions. Fig. 2. Histopathologic examination of a punch biopsy taken from the patient’s neck, showing (A) hyperkeratosis and parakeratosis (arrows) (H&E, ×40). (B) Higher magnification showing parakeratotic corneocytes containing multiple basophilic granules (arrows), similar to keratohyaline granules (H&E, ×400). These changes were especially prominent in the stratum corneum of eccrine ostia. antiperspirants, occlusion, excessive use of creams, and obesity. On the molecular level, granular parakeratosis has been associated with abnormalities in profilaggrin processing5, suggesting that the various aforementioned triggering factors may interfere with profilaggrin pro- cessing, resulting in granular parakeratosis. Granular para- keratosis may also be an epiphenomenon of molluscum contagiosum 6 , dermatomyositis7, fungal infection8, or carcinoma9. In our patient, granular parakeratosis was not an incidental finding because several lesions showed the same clinical findings of verrucous papules. Histopathologically, granular parakeratosis is characterized by hyperkeratosis and prominent parakeratosis of the stratum corneum. Under high resolution, parakeratotic 204 Ann Dermatol corneocytes have been found to contain keratohyaline granules, which are regarded as diagnostic. Although most patients with this condition have diffuse granular para- keratosis, some have variants such as follicular granular parakeratosis10 and granular parakeratosis of the eccrine ostia1. Patients with the latter showed similar clinical presen- tation to our case; black and brownish spiny papules on the neck, which appeared in August, as well as experi- encing a tingling sensation upon sweating1. The similar clinical manifestations and histopathologic findings of both conditions suggest that the pathomechanism of granular parakeratosis related with eccrine structures may be associated with sweating or high temperature. Another