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

Aasiya Rajbhandari,Bibush Amatya,Mm Aarif Syed,Rashmi Sharma

doi:10.3126/njdvl.v18i1.25594

Abstract

Confluent and reticulated papillomatosis of Carteaud and Gougerot is a keratinization disorder with an infective aetiology. Patients present with hyperpigmented papules on the upper trunk and axillae that coalesce centrally and demonstrate reticulation peripherally. Diagnosis is based on clinical findings, characteristic histopathologic changes and response to therapy. We report a case of a young Nepali male who presented with gradual onset of asymptomatic raised dark brown lesions on his neck, trunk and axillae over the course of eight years. The condition was previously misdiagnosed as pityriasis versicolor and had received oral and topical antifungals. The diagnosis was revised to confluent and reticulated papillomatosis based on clinical and histopathological examination. He was subsequently started on oral minocycline 50 mg twice daily and nightly application of topical tretinoin 0.05% gel. There was complete resolution of all his lesions except for residual hyperpigmentation at the end of two months of therapy. There has been no relapse six months from the end of therapy. This is to our knowledge, the first case of confluent and reticulated papillomatosis reported from Nepal. Oral minocycline and topical tretinoin should be considered first line in the treatment of confluent and reticulated papillomatosis.

Highlights

Confluent 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]
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]
The differentials that we had considered in our case were acanthosis nigricans, pityriasis versicolor, terra firma-forme dermatosis and Darier disease

Summary

Introduction

Confluent 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] The treatment options include tetracycline and macrolide antibiotics, oral and topical retinoids, oral and topical antifungals and topical calcineurin inhibitors.[1]. A 23-year-old Nepali male presented to our hospital with a 7-year history of asymptomatic, brownish skin lesions in his neck, trunk and axillae. The lesions started on the trunk and slowly spread to the axillae and neck over several years. He had been treated with oral and topical antifungals in the past which did not lead to any improvement. There were multiple hyperpigmented papules on the upper chest, back, neck, upper arms and axillae, which had coalesced centrally to form plaques while demonstrating reticulation peripherally (Figure 1)

Discussion

Findings

Conclusions