Confluent and reticulated papillomatosis successfully treated with amoxicillin

Confluent and reticulated papillomatosis with eruptions on the trunk and extremities

Dear Editor, Confluent and reticulated papillomatosis (CRP) is a rare skin disorder in young individuals. It is clinically characterized by slightly hyperkeratotic or verrucous grayish-brown papules coalescing to form a reticulated pattern peripherally with confluent plaques centrally. Sites of predilection are the neck, interscapular, intermammary regions, and abdomen. CRP commonly arises during puberty or in early adulthood. Herein, we describe an atypical case of CRP in which the skin lesions developed not only on the abdomen, as a site of predilection, but also on broad areas of the extremities.

Clinical and Histopathologic Study of Confluent and Reticulated Papillomatosis by Anatomic Site and Age

Background

Confluent and reticulated papillomatosis (CRP) is an uncommon dermatosis characterized by hyperpigmented scaly macules or papillomatous papules coalescing into confluent patches or plaques centrally with a reticular pattern peripherally. Few studies regarding this have been reported in the literature.

Objective

The purpose of this study was to investigate the clinical and histologic characteristics of CRP in Korean patients according to anatomic site and age.

Methods

We retrospectively reviewed the medical records, clinical photographs, and 40 histopathologic slides of 29 patients diagnosed with CRP.

Results

Sixteen adults and 13 adolescents were included. The predominantly involved anatomic sites were the trunk (89.7%) and axillae (27.6%); flexural area involvement was mainly found in the adolescent group. The mean disease duration was 2.3 times longer in the adult group than in the adolescent group. The histopathologic features included hyperkeratosis (95.0%), acanthosis (87.5%), and papillomatosis (77.5%) in the epidermis. In the adult group, only 10 specimens (52.6%) showed mild to moderate papillomatosis. There was no relationship between the histologic findings and disease duration; however, the former was associated with the anatomic site.

Conclusion

The present study is the first to present the clinical and histologic features of CRP according to age and anatomic site in Korean patients. The patients in this study more frequently had fungal infections (31%) than patients in a previous study (12.8%). Histologic changes were more prominent in the adolescent group than in the adult group and in the flexural area than in the non-flexural area.

Confluent and reticulated papillomatosis: diagnostic and treatment challenges

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 1280(T)), 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.

Clinicopathological and diagnostic characterization of confluent and reticulate papillomatosis of Gougerot and Carteaud: a retrospective study in a South-East Asian population

BACKGROUND

Confluent and reticulate papillomatosis of Gougerot and Carteaud (CRP) is a rare dermatological condition, which has not been reported widely in Asian populations.

AIM

To characterize the clinicopathological and diagnostic features of CRP in a South-East Asian population.

METHODS

The medical records of 29 patients accorded the diagnosis of CRP at the National Skin Centre, Singapore, from 1990 to 2011, were analyzed.

RESULTS

The male to female ratio was 2.6:1. Eight patients were Indians. The mean age at the onset of skin eruptions was 29.1 years (range 16-55 years), while the mean duration was 19.9 months (range 0.5-120 months). CRP itself was the most common preliminary diagnosis. Fungal smears were negative in all 22 instances. All 29 patients had received a trial of antifungal therapy before being seen at our center. Antifungal therapy was repeated in three subjects, and the response was uniformly poor. Conversely, the treatment response with tetracyclines was excellent, yielding more than a 50% response in all 14 patients. Four patients suffered recurrence of CRP. According to the diagnostic criteria set forth by Davis et al., 25/29 patients (86.2%) and 19/29 patients (65.6%) fulfilled at least three and four criteria, respectively.

CONCLUSION

A predilection for male gender and Indian ethnicity were noted in our study. The diagnosis of CRP was often made clinically, and investigations were mainly ancillary. The treatment response was poor with antifungal agents but excellent with tetracyclines. The diagnostic criteria proposed by Davis et al. were found to be useful in our cohort of patients.