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 "Acquired 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. CARP occurs in both males and females .
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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Scheinfeld N. Confluent and reticulated papillomatosis : a review of the literature. Am J Clin Dermatol 2006; 7:305.
- Tamraz H, Raffoul M, Kurban M, et al. Confluent and reticulated papillomatosis: clinical and histopathological study of 10 cases from Lebanon. J Eur Acad Dermatol Venereol 2013; 27:e119.
- Davis MD, Weenig RH, Camilleri MJ. Confluent and reticulate papillomatosis (Gougerot-Carteaud syndrome): a minocycline-responsive dermatosis without evidence for yeast in pathogenesis. A study of 39 patients and a proposal of diagnostic criteria. Br J Dermatol 2006; 154:287.
- Jimbow M, Talpash O, Jimbow K. Confluent and reticulated papillomatosis: clinical, light and electron microscopic studies. Int J Dermatol 1992; 31:480.
- Griffiths CE. Gougerot-Carteaud still an enigma after all these years. J Dermatolog Treat 2002; 13:1.
- Inalöz HS, Patel GK, Knight AG. Familial confluent and reticulated papillomatosis. Arch Dermatol 2002; 138:276.
- Schwartzberg JB, Schwartzberg HA. Response of confluent and reticulate papillomatosis of Gougerot and Carteaud to topical tretinoin. Cutis 2000; 66:291.
- Henning JP, de Wit RF. Familial occurrence of confluent and reticulated papillomatosis. Arch Dermatol 1981; 117:809.
- Baden HP. Familial cutaneous papillomatosis. Arch Dermatol 1965; 92:394.
- Stein JA, Shin HT, Chang MW. Confluent and reticulated papillomatosis associated with tinea versicolor in three siblings. Pediatr Dermatol 2005; 22:331.
- Gülec AT, Seçkin D. Confluent and reticulated papillomatosis: treatment with topical calcipotriol. Br J Dermatol 1999; 141:1150.
- Ginarte M, Fabeiro JM, Toribio J. Confluent and reticulated papillomatosis (Gougerot-Carteaud) successfully treated with tacalcitol. J Dermatolog Treat 2002; 13:27.
- Bowman PH, Davis LS. Confluent and reticulated papillomatosis: response to tazarotene. J Am Acad Dermatol 2003; 48:S80.
- Lee D, Cho KJ, Hong SK, et al. Two cases of confluent and reticulated papillomatosis with an unusual location. Acta Derm Venereol 2009; 89:84.
- Kim BS, Lim HJ, Kim HY, et al. Case of minocycline-effective confluent and reticulated papillomatosis with unusual location on forehead. J Dermatol 2009; 36:251.
- Davis RF, Harman KE. Confluent and reticulated papillomatosis successfully treated with amoxicillin. Br J Dermatol 2007; 156:583.
- Kim MR, Kim SC. Confluent and reticulated papillomatosis on the arm successfully treated with minocycline. J Dermatol 2010; 37:749.
- Jo S, Park HS, Cho S, Yoon HS. Updated diagnosis criteria for confluent and reticulated papillomatosis: a case report. Ann Dermatol 2014; 26:409.
- Hallel-Halevy D, Grunwald MH, Halevy S. Confluent and reticulated papillomatosis (Gougerot-Carteaud) of the pubic region. Acta Derm Venereol 1993; 73:155.
- Sakiyama T, Amagai M, Ohyama M. Chronology of confluent and reticulated papillomatosis: spontaneous regression in a case after long-term follow-up may imply transient nature of the condition. J Dermatol 2015; 42:335.
- Groh V, Schnyder UW, Sigg C. 'Papillomatose papuleuse confluente et réticulée Gougerot-Carteaud'--a further form of skin amyloidosis? Dermatologica 1981; 162:118.
- Groh V, Sigg C, Schnyder UW. New histochemical and ultrastructural findings in three cases of 'papillomatose papuleuse confluente et réticulée (Gougerot-carteaud)'. Dermatologica 1982; 165:145.
- Zalewska-Kaszubska J, Górska D. Anti-inflammatory capabilities of macrolides. Pharmacol Res 2001; 44:451.
- Sapadin AN, Fleischmajer R. Tetracyclines: nonantibiotic properties and their clinical implications. J Am Acad Dermatol 2006; 54:258.
- Monk E, Shalita A, Siegel DM. Clinical applications of non-antimicrobial tetracyclines in dermatology. Pharmacol Res 2011; 63:130.
- Jang HS, Oh CK, Cha JH, et al. Six cases of confluent and reticulated papillomatosis alleviated by various antibiotics. J Am Acad Dermatol 2001; 44:652.
- Yamamoto A, Okubo Y, Oshima H, et al. Two cases of confluent and reticulate papillomatosis: successful treatments of one case with cefdinir and another with minocycline. J Dermatol 2000; 27:598.
- Sassolas B, Plantin P, Guillet G. Confluent and reticulated papillomatosis: treatment with minocycline. J Am Acad Dermatol 1992; 26:501.
- Poskitt L, Wilkinson JD. Clearance of confluent and reticulate papillomatosis of Gougerot and Carteaud with minocycline. Br J Dermatol 1993; 129:351.
- Katayama I, Yokozeki H, Nishioka K. Oral minocycline improved keratosis follicularis squamosa (Dohi) and related disorder: bacterial factors are possibly involved in abberant keratinization. J Dermatol 1994; 21:604.
- Shimizu S, Han-Yaku H. Confluent and reticulated papillomatosis responsive to minocycline. Dermatology 1997; 194:59.
- Puig L, de Moragas JM. Confluent and reticulated papillomatosis of Gougerot and Carteaud: minocycline deserves trial before etretinate. Arch Dermatol 1995; 131:109.
- Chang SN, Kim SC, Lee SH, Lee WS. Minocycline treatment for confluent and reticulated papillomatosis. Cutis 1996; 57:454.
- Montemarano AD, Hengge M, Sau P, Welch M. Confluent and reticulated papillomatosis: response to minocycline. J Am Acad Dermatol 1996; 34:253.
- Fung MA, Frieden IJ, LeBoit PE, et al. Confluent and reticulate papillomatosis: successful treatment with minocycline. Arch Dermatol 1996; 132:1400.
- Atasoy M, Ozdemir S, Aktaş A, et al. Treatment of confluent and reticulated papillomatosis with azithromycin. J Dermatol 2004; 31:682.
- Gruber F, Zamolo G, Saftić M, et al. Treatment of confluent and reticulated papillomatosis with azithromycin. Clin Exp Dermatol 1998; 23:191.
- Ito S, Hatamochi A, Yamazaki S. A case of confluent and reticulated papillomatosis that successfully responded to roxithromycin. J Dermatol 2006; 33:71.
- Lee MP, Stiller MJ, McClain SA, et al. Confluent and reticulated papillomatosis: response to high-dose oral isotretinoin therapy and reassessment of epidemiologic data. J Am Acad Dermatol 1994; 31:327.
- Carrozzo AM, Gatti S, Ferranti G, et al. Calcipotriol treatment of confluent and reticulated papillomatosis (Gougerot-Carteaud syndrome). J Eur Acad Dermatol Venereol 2000; 14:131.
- Lang EW, Czosnyka M, Mehdorn HM. Tissue oxygen reactivity and cerebral autoregulation after severe traumatic brain injury. Crit Care Med 2003; 31:267.
- Tirado-Sánchez A, Ponce-Olivera RM. Tacrolimus in confluent and reticulated papillomatosis of Gougerot Carteaud. Int J Dermatol 2013; 52:513.
- Angeli-Besson C, Koeppel MC, Jacquet P, et al. Confluent and reticulated papillomatosis (Gougerot-Carteaud) treated with tetracyclines. Int J Dermatol 1995; 34:567.
- Erkek E, Ayva S, Atasoy P, Emeksiz MC. Confluent and reticulated papillomatosis: favourable response to low-dose isotretinoin. J Eur Acad Dermatol Venereol 2009; 23:1342.
- Hodge JA, Ray MC. Confluent and reticulated papillomatosis: response to isotretinoin. J Am Acad Dermatol 1991; 24:654.
- Solomon BA, Laude TA. Two patients with confluent and reticulated papillomatosis: response to oral isotretinoin and 10% lactic acid lotion. J Am Acad Dermatol 1996; 35:645.
- Bruynzeel-Koomen CA, de Wit RF. Confluent and reticulated papillomatosis successfully treated with the aromatic etretinate. Arch Dermatol 1984; 120:1236.
- Baalbaki SA, Malak JA, al-Khars MA. Confluent and reticulated papillomatosis. Treatment with etretinate. Arch Dermatol 1993; 129:961.
- 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