By Gary M. White, MD
Confluent and reticulated papillomatosis (CRP) (of Gougerot and Carteaud) presents as symmetric pigmented plaques of the mid-chest and axilla in adolescents and young adults.
Confluent and reticulated brown papules and plaques occurring in the mid chest is characteristic. They may also involve the back, neck, abdomen, axilla and inframammary area. A non-pigmented variety may occur [Pediatric Dermatology;2006;23;497]. Of note, it has been proposed that prurigo pigmentosa is an inflammatory version of confluent and reticulated papillomatosis.
No treatment is needed. The oral tetracyclines are usually very effective (e.g., doxycycline or minocycline 100 mg BID for 1-3 months) and may be considered first-line therapy.
Other antibiotics that have been used include: fusidic acid 500 mg daily for 4 weeks, clarithromycin 500 mg daily for 5 weeks, erythromycin 500 mg daily for 6 weeks, and azithromycin 500 mg daily for 3 weeks. It is postulated that these antibiotics eliminate the bacterial agents which are responsible for inducing the epidermal proliferative changes. Benzoyl peroxide wash has been recommended to prevent recurrences.
Topical steroids, keratolytics, and retinoids (e.g., tretinoin or tazarotene 0.1% gel BID x 2 months) have their supporters.
For widespread clearing, isotretinoin (e.g., up to 2.0 mg/kg/day), or acitretin may be employed. A high-potency topical steroid cleared the disease in one of my patients. A topical cream containing 12% urea and 0.03% tretinoin BID cleared two patients [BJD 1996;134;381].
Seventy percent alcohol swabbing has been used.
Unilateral, hypopigmented CRP in a young woman.