Papilomatosis confluente y reticulada de Gougerot-Carteaud / Confluent and reticulated papillomatosis of Gougerot-Carteaud

La papilomatosis confluente y reticulada es una dermatosis infrecuente, benigna, de curso crónico y etiopatogenia desconocida. Actualmente, se acepta que se debe a un trastorno de la queratinización. Se caracteriza por máculas y pápulas hiperpigmentadas, que coalescen en el centro y adoptan un patrón reticular en la periferia. Se la puede confundir con otras patologías, como la pitiriasis versicolor y la acantosis nigricans. Con la administración de minociclina por vía oral suelen obtenerse excelentes resultados. Se comunica el caso de un paciente con diagnóstico de papilomatosis confluente y reticulada. Se describen sus características clínicas, criterios diagnósticos y trata-miento instaurado.

Confluent and reticulated papillomatosis is an infrequent, benign dermatosis of chronic course and unknown etiopathogenesis. Currently it is accepted that this dermatosis is due to a keratinization disorder. It is characterized by hyperpigmented macules and papules that coalesce in the center and adopt a reticular pattern in the periphery. It can be confused with other pathologies such as pityriasis versicolor and acanthosis nigricans. Oral minocycline usually shows excellent results. The present work reports a case of a patient with a diagnosis of confluent and retic-ulated papillomatosis, describing its clinical characteristics, diagnostic criteria and established treatment.

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 Limited to the Forearm / 대한피부과학회지

No abstract available.

A Case of Confluent and Reticulated Papillomatosis Treated with Oral Isotretinoin / 대한피부과학회지

No abstract available.

Topical Tretinoin Treatment for Confluent and Reticulated Papillomatosis / 대한피부과학회지

BACKGROUND: Confluent and reticulated papillomatosis (CRP) is a rare cutaneous disorder, characterized by persistent, scaling brown papules, patches, and plaques located on the trunk, neck, axillae, and shoulders. Many different treatments with variable success have been attempted, and oral minocycline treatment is effective in most patients with CRP. There were a few case reports of CRP responding to topical retinoid, but no clinical studies on the efficacy of the topical retinoid treatment for CRP have been reported. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of the topical tretinoin treatment for CRP. METHODS: A retrospective study was performed based on the medical records and clinical photographs of patients with CRP treated with 0.025% tretinoin cream. RESULTS: Nine patients (4 men and 5 women) were enrolled in the study. The mean age of the patients was 17.4 (11~34) years and the mean age at onset of CRP was 15.1 (3~33) years. The duration of disease varied from 1 month to 7 years. Six of the nine patients showed complete remission, and CRP lesions improved markedly after averagely 6.2 weeks from the beginning of the topical tretinoin treatment. The treatment response was better in patients without itch than in patients with itch (p=0.048). Adverse effects were detected in 3 patients, and were mild irritant contact dermatitis to the topical tretinoin. CONCLUSION: We think that topical 0.025% tretinoin treatment is an effective and safe treatment modality for CRP and this treatment can be an alternative or additional modality to the systemic treatment.

Confluent and Reticulated Papillomatosis without Papillomatosis / 대한피부과학회지

Confluent and reticulated papillomatosis (CRP) was first described as a relatively rare dermatosis. CRP is characterized by slightly hyperkeratotic pigmented papules that are confluent in the center and reticulated at the periphery, located on the neck, abdomen, intermammary, and interscapular regions. Histopathologically, lesions typically reveal orthohyperkeratosis, papillomatosis, and focal acanthosis. A 20-year-old man presented with a 2-year history of slightly pruritic lesions on the chest, abdomen, back, and upper extremities. The lesions were brownish papules and plaques in a reticulated and coalescing pattern. Histologically, a basket-weave pattern of orthohyperkeratosis and mild acanthosis were seen. However, there was no significant papillomatosis, even in multiple sections. Periodic acid Schiff stain was negative for fungi. The patient was treated with doxycycline, 200 mg daily, for 4 weeks. The lesions completely resolved and did not recur during 12 months of follow-up. We report a rare case of CRP without papillomatosis.

Papilomatosis reticulada y confluente de Gougerot-Carteaud: un caso con excelente respuesta a minociclina / Confluent and reticulated Gougerot-Carteaud papillomatosis: a case report of an excellent response to minocycline

La papilomatosis reticulada y confluente de Gougerot-Carteaud es una dermatosis poco frecuente que por lo general afecta a individuos jóvenes, especialmente a mujeres de fototipos oscuros. Es asintomática y se presenta como placas pigmentadas con textura papilomatosa que confluyen formando placas reticuladas de mayor tamaño en el cuello y zonas intertriginosas. La causa es desconocida, aunque se ha implicado una queratinización anormal, y en ocasiones se puede asociar a Malassezia sp. Su evolución es crónica con remisiones y exacerbaciones. Por el momento no se dispone de un tratamiento específico. Se presenta un caso tratado de manera efectiva con minociclina que no presentó recidiva tras seis meses de seguimiento.

Confluent and reticulated Gougerot-Carteaud papillomatosis is an uncommon dermatological condition that affects adolescents, especially young women with dark skin types. It presents itself as asymptomatic pigmented patches with a papillomatous texture that coalesce to form reticular plaques localized in the neck and intertriginous areas. The cause of this disease is unknown, although an abnormal keratinization has been implicated and sometimes has been associated with Malassezia sp. It has a chronic course with remissions and exacerbations. Several therapies have been used unsuccessfully to eradicate it but nowadays there is no specific treatment. We report a case treated efficiently with minocycline without recurrence at 6 months follow-up.

Three Cases of Concomitant Acanthosis Nigricans with Confluent and Reticulated Papillomatosis in Obese Patients

Acanthosis nigricans (AN) is characterized by symmetric, velvety, gray-brown hypertrophied plaques most commonly on the axillae and neck. Confluent and reticulated papillomatosis (CRP) is manifested by papules in the mid-chest that coalesce in the midline, and are arranged in a reticulated pattern peripherally. Both diseases are known to be related to endocrinopathies such as diabetes mellitus (DM), an insulin resistant state and obesity with unknown mechanisms. Herein, we presented three cases of concomitant acanthosis nigricans with confluent and reticulated papillomatosis in obese patients.

Therapeutic Effects of Various Antibiotics for the Confluent and Reticulated Papillomatosis / 대한피부과학회지

BACKGROUND: Confluent and reticulated papillomatosis(CRP), the least common of the cutaneous papillomatoses, is manifested by persistent papules that are confluent in center and reticulated at the periphery. Recently, many cases of CRP treated with minocycline have been reported. METHODS: Thirteen patients with CRP were included in this study. They were treated with various antibiotics, such as erythromycin, tetracycline, doxycycline, and minocycline. The patients have taken antibiotics twice a day for 4 weeks. They were followed-up at 4, 8, 12, and 16 weeks after treatment. We assessed about therapeutic effects, side effects, and recurrence, by phone 1 year after treatment. RESULTS: Of the total 13 patients, 9 patients had improved by more than 95% in response to various antibiotics therapy for 4 months. One patient had a mild adverse reaction and two patients symptoms recurred after 1 year follow-up. CONCLUSION: We recommended various antibiotics therapy as the first choice of treatment for CRP because those were safe, economic, and effective.

Confluent and Reticulated Papillomatosis Successfully Treated with Minocycline

Confluent and reticulated papillomatosis (Gougerot and Carteaud) is a rare but clinically distinct dermatosis of which the etiology is unknown. We report 2 cases. One case is a 16-year-old boy who had a hyperpigmented reticulated eruption on the trunk and both arms and the other case is a 33-year-old man who had a similar eruption on the chest and back. The former, with previous treatment with oral and topical antifungal agent in another clinic didn't show any improvement and the latter case, with initial treatment of itraconazole did not improve his skin lesion. The rashes of two patients virtually disappeared with administration of minocycline. These observations indicate that the role of microorganisms sensitive to minocycline or anti- proliferative effect of minocycline could be presumed.

A Study on the Role of Bacteria in the Pathogenesis of Confluent and Reticulated Papillomatosis / 대한피부과학회지

BACKGROUND: The pathogenesis of confluent and reticulated papillomatosis(CRP) is still unknown, although many theories have been suggested. It is stressed that abnormal host response to colonization of pityrosporum orbiculare might play a role in the pathogenesis of CRP, but is not completely understood. Frequently, we have observed bacterial colonies in the stratum corneum and, especially, within the hair follicles from biopsy specimens of patients with CRP. In addition, successful treatment for CRP with minocycline, a derivative of tetracyclines, has been reported continuously. OBJECTIVE: The purpose of this study was to document the possible association of bacterial factors in the pathogenesis of CRP and to elucidate the effectiveness of minocycline. METHODS: We performed Brown and Brenn gram staining in 12 biopsy specimens, bacterial cultures, identification of microorganisms and antibiotics sensitivity testing including minocycline. We administered oral minocycline with an initial dose of 100mg per day for 1 to 3 months and a maintenance dose 50mg per day for I to 2 months, then evaluated the response of treatment. RESULTS: 1. On Brown and Brenn staining, the gram positive bacterial colonies that stained dark bluish or nearly black were observed within the infundibulum of hair follicles in 10 out of 12 biopsy specimens(83.3%) and on the keratotic invagination of stratum corneum in 11 out of 12 biopsy specimens(91.7%). 2. Histological features of regions where bacterial colonies were observed showed, hyperkeratosis and keratotic invagination on the stratum corneum in all cases. Hyperkeratosis(66.7%), parakeratosis(16.7%), inflammatory cell infiltration(25.0%), perifollicular fibrosis(33.3%), and abnormal keratin in sebaceous ducts(50.0%) were shown in hair follicles. 3. In anaerobic cultures, no bacteria was grown. In aerobic cultures, staphylococcus species were identified in 6 cases, streptococcus viridans in one case, sternotrophomonas maltophilia in one case. In the susceptibiliity test, minocycline was sensitive in 7 from 8 cases. 4. The therapeutic response to minocycline was observed within one month in all cases, and the time to clear the lesions was 1/2 month in 2 cases, 1 month in 4 cases, 2 months in 5 cases, 3 months in one case, respectively. CONCLUSION: Form these results, we suggest that bacterial factors may play an important role in the pathogenesis of CRP and that the action mechanism of minocycline in the treatment of CRP may be due to antibacterial effects.

Therapeutic Effect of Minocycline on Confluent and Reticulated Papillomatosis / 대한피부과학회지

BACKGROUND: Confluent and reticulate papillomatosis(CRP) of Gougerot and Carteaud is an uncommon disorder of unknown cause for which a variety of treatments have been proposed. OBJECTIVE: We attempted to evaluate the therapeutic effect of oral minocycline for CRP. METHOD: Nine patients(age range, 14 to 38; mean age, 21years) with CRP were included in this study. They took minocycline 100mg daily. The therapeutic effect was evaluated weekly by 5 scoring systems according to the percentage clearing of the skin lesion: poor (score 1), 95%. RESULTS: Two out of 9 patients showed complete clearing(score 5) of the skin lesions within 2 weeks. Seven patients revealed incomplete clearing(score 4) within 3 to 8 weeks. The mean scoring for 9 CRP patients was 4.2. Recurrences were noted in two patients at 24 and 26 months, respectively, but they responded to re-treatment with minocycline. The patients did not show any adverse reactions apart from two patients who developed mild pruritus. CONCLUSION: We recommend minocycline as the first choice of treatment for CRP because minocycline is safe, economic and effective.

A Case of Confluent and Reticulated Papillomatosis: Treatment with Etretinate / 대한피부과학회지

Confluent and reticulated papillomatosis(CRP) is a rare dermatosis. The lesions are hyperkeratotic, verrucous papules and plaques, resulting in a confluence of lesions centrally and a reticulated pattern at the periphery. It is more common in women and during puberty. The histopathological findings show papillomatosis, hyperkeratosis and a sparse superficial perivascular lymphocytic infiltrate. We report a case of CRP that responded to oral etretinate in an 18-year-old man.