Confluent and reticulated papillomatosis

Confluent and reticulated papillomatosis (CRP) is also known as Gougerot-Carteaud Syndrome. Gourgerot and Carteaud originally described the condition in 1927.

What is confluent and reticulated papillomatosis?

CRP is a rare skin disease characterised by:

• Greyish blue-brown 1-5mm flat scaly, wart-like bumps
• Lesions join up 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 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

The condition is more common in young women than in men (except in Japan where the reverse is true) and usually starts soon after puberty. The condition is chronic with exacerbations and remissions. In some cases, after spreading slowly for a few years, the lesions remain permanently unchanged and cause no symptoms.

What is the cause of confluent and reticulated papillomatosis?

The cause of CRP is unknown. Several possible causes have been suggested and include:

• Hormonal disturbance – often CRP is associated with hormonal abnormalities such as diabetes mellitus, thyroid disease, obesity
• Microscopic studies show increased turnover of cells and increased production of the skin protein, keratin. CRP appears to respond to medication that regulates cell development and prevents skin cell growth.
• Yeast infection – presence of Malassezia organisms in some CRP cases that clear with antifungal treatment
• Bacterial infection – some CRP cases respond to antibacterial treatment. Recently an actinomycete called Dietzia was reportedly isolated from a patient with confluent and reticulated papillomatosis.¹
• Hereditary – several reports of CRP occurring in more than one family member

What is the treatment for confluent and reticulated papillomatosis?

CRP is a benign skin disorder that results in cosmetic disfigurement. As mentioned earlier it is a chronic disorder with exacerbations and remissions. Several therapies have been used in an attempt to clear the condition and prevent it from recurring.

• Minocycline clears CRP in most patients, for unknown reasons.
• Systemic antifungal agents and topical antifungal agents directed against Malassezia infection may be helpful.
• Topical tretinoin (a vitamin A derivative or retinoid) reduces abnormal skin turnover so can flatten out the warty areas.
• Systemic retinoids (e.g. isotretinoin or acitretin) may be used to correct abnormal skin turnover.
• Other antibiotics may be helpful.
• Calcipotriol cream appears to be effective in some cases.
• Treating any underlying disorders (e.g. weight loss)

Discontinuation of successful treatment may result in a recurrence of the condition.