Confluent and reticulated papillomatosis
What is confluent and reticulated papillomatosis?
CRP is a rare skin disease characterised by a network pattern of discoloured small flat plaques. It mainly affects the mid trunk of young adults.
Confluent and reticulated papillomatosis is also known as Gougerot-Carteaud Syndrome. Gourgerot and Carteaud originally described the condition in 1927.
Who gets confluent and reticulated papillomatosis?
Confluent and reticulated papillomatosis is more common in young women than in men (except in Japan where the reverse is true) and usually starts soon after puberty.
What is the cause of confluent and reticulated papillomatosis?
The cause of confluent and reticulated papillomatosis is unknown. Several possible causes have been suggested and include:
- Hormonal disturbance – it has been associated with hormonal abnormalities such as diabetes mellitus, thyroid disease and obesity
- Proliferation of keratinocytes — microscopic studies show increased turnover of cells and increased production of the skin protein, keratin.
- Yeast infection – Malassezia is found in some cases and these may clear with antifungal treatment
- Bacterial infection – some cases respond to antibacterial treatment. An actinomycete called Dietzia was isolated from a patient with confluent and reticulated papillomatosis .
- Hereditary factors – there are several reports of CRP occurring in more than one family member.
What are the clinical features of confluent and reticulated papillomatosis?
Confluent and reticulated papillomatosis causes no symptoms. Characteristics are:
- Greyish blue-brown 1-5mm flat scaly, wart-like bumps
- Confluence of papules to form larger patches with a net-like pattern on the edges
- First lesions usually appear between the breasts and in the midline of the back and gradually spread over the breasts, to include the neck, armpits and abdomen
- Sometimes lesions may appear spread across the shoulders, in the pubic areas, and on the face.
- Lesions are usually symptomless but some patients may have mild pruritus (itching)
Confluent and reticulated papillomatosis is chronic with exacerbations and remissions. In some cases, after spreading slowly for a few years, the lesions remain permanently unchanged.
What is the treatment for confluent and reticulated papillomatosis?
Confluent and reticulated papillomatosis is a benign skin disorder that results in cosmetic disfigurement. Several therapies have been used in an attempt to clear the condition and prevent it from recurring but response is inconsistent. Weight loss has been advocated in those that are overweight.
- Minocycline — this appears to be the most effective treatment, for unknown reasons.
- Systemic antifungal agents and topical antifungal agents directed against Malassezia
- Other antibiotics
Medication that regulates cell development and prevents skin cell growth
- Topical tretinoin (a vitamin A derivative or retinoid)
- Systemic retinoids (e.g. isotretinoin or acitretin)
- Topical calcipotriol
Discontinuation of successful treatment may result in a recurrence of the condition.