Confluent and reticulated papillomatosis
- Amy Y-Y Chen, MD, FAAD
Amy Y-Y Chen, MD, FAAD
- Assistant Professor, Department of Dermatology
- University of Connecticut School of Medicine
Confluent and reticulated papillomatosis (CARP) is an uncommon dermatosis characterized by hyperpigmented scaly macules or papillomatous papules coalescing into confluent patches or plaques centrally with a reticular pattern peripherally (picture 1A-D). It most commonly occurs on the trunk. Oral antibiotic therapy is the mainstay of treatment.
The clinical features, diagnosis, and management of CARP will be reviewed here. Other causes of cutaneous hyperpigmentation are reviewed separately. (See "Approach to the patient with hyperpigmentation disorders".)
First described by two French dermatologists, Gougerot and Carteaud, CARP has been reported worldwide and occurs in all racial groups and ethnicities . It is estimated that the incidence of CARP in the Lebanese population is around 0.02 percent . No epidemiologic study has been conducted in the United States. However, only 39 patients were identified in a retrospective review collected from 1972 to 2003 at the Mayo Clinic .
CARP typically affects young adults; the Mayo Clinic retrospective study found a mean age of onset of 15 years and a range of 8 to 32 years. While some studies report a slight female predominance with a female-to-male ratio of 1.4:1, others do not demonstrate sex predilection .
Decades after its initial description, the pathogenesis and etiology of CARP remain elusive and controversial. Several theories have been proposed, although none have been definitively proven.
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- CLINICAL PRESENTATION
- DIFFERENTIAL DIAGNOSIS
- First-line therapy
- - Minocycline
- Second-line therapy
- - Macrolide antibiotics
- Other therapies
- - Topical agents
- - Alternative oral antibiotics
- - Oral retinoids
- SUMMARY AND RECOMMENDATIONS