Confluent and reticulated papillomatosis: diagnostic and treatment challenges

Abstract

Confluent and reticulated papillomatosis (CRP) of Gougerot and Carteaud was first typified in 1927. With the help of electron microscopy, it has been elucidated that CRP arises due to aberrant keratinization. However, till date, there is no clear consensus on the etiologic trigger for CRP. Prevailing postulates include a bacterial trigger by Dietzia papillomatosis (type strain N 1280T), an exaggerated cutaneous response to Malassezia furfur, an endocrine basis stemming from insulin resistance, ultraviolet light-induced epidermal change, amyloid deposition, and a loss-of-function mutation in keratin 16. CRP typically presents as asymptomatic hyperpigmented papules and plaques with peripheral reticulation over the nape, axillae, upper chest, and upper back, occasionally with extension superior to the forehead and inferior to the pubic region. Dermoscopy may be used in the evaluation of CRP, but its diagnosis is made on clinical grounds given its nonspecific histopathological findings. Although successful treatment with topical keratolytics, retinoids, or antifungals has been reported, antibiotics, such as minocycline, at anti-inflammatory doses have emerged as a preferred therapeutic option. In this article, we review the diagnostic considerations in CRP and its therapeutic options.

Confluent and Reticulated Papillomatosis of Carteaud and Gougerot in a Young Nepali Male

“…CRP usually occurs in young adults with asymptomatic brown to hyperpigmented papules on the upper trunk, axillae and neck. 1 An infective aetiology was confirmed based on response of the condition to antimicrobials and the demonstration of Dietzia papillomatosis on the skin scrapings by Jones et al 2 It has also been associated with pregnancy, insulin resistance, obesity, pituitary and thyroid disorders and can also be familial. 3 The diagnosis is based on the criteria developed by Davis et al 4 in 2006, which is as follows: (i) presence of scaly brown macules and patches, some of which are reticulated and papillomatous; (ii) upper trunk and neck involvement; (iii) absence of fungus on skin scales; (iv) absence of response to antifungal treatment; and (v) excellent response to minocycline.…”

“…C onfluent and reticulated papillomatosis (CRP) was first described by Gougerot and Carteaud in 1927. 1 It is a rare condition that typically develops in young adults and presents with dark brown papules on the upper trunk and axillae that coalesce centrally and become reticulated peripherally. 1 It is assumed to be a disorder of keratinization with an infective aetiology based on histopathological features and its response to antibiotics and retinoids.…”

“…1 It is a rare condition that typically develops in young adults and presents with dark brown papules on the upper trunk and axillae that coalesce centrally and become reticulated peripherally. 1 It is assumed to be a disorder of keratinization with an infective aetiology based on histopathological features and its response to antibiotics and retinoids. 1 The treatment options include tetracycline and macrolide antibiotics, oral and topical retinoids, oral and topical antifungals and topical calcineurin inhibitors.…”

“…1 It is assumed to be a disorder of keratinization with an infective aetiology based on histopathological features and its response to antibiotics and retinoids. 1 The treatment options include tetracycline and macrolide antibiotics, oral and topical retinoids, oral and topical antifungals and topical calcineurin inhibitors. 1 Herein, we report a case of CRP in a young adult which responded to oral minocycline in combination with topical retinoid.…”

“…1 The treatment options include tetracycline and macrolide antibiotics, oral and topical retinoids, oral and topical antifungals and topical calcineurin inhibitors. 1 Herein, we report a case of CRP in a young adult which responded to oral minocycline in combination with topical retinoid.…”