Confluent and reticulated papillomatosis (CARP), also known as Gougerot-Carteaud syndrome is a rare disorder first described by Gougerot and Carteaud in 1927 [1]. It occurs in all age groups, races, and genders. Usually, patients are asymptomatic. However, they may experience mild pruritus. The lesions are most commonly observed on the trunk [2]. Physical findings are limited to the skin.

CARP lesions begin as papules of 1 to 2 millimeters in diameters that are slightly hyperkeratotic to warty. They enlarge to form 4 to 5 millimeters lesions which coalesce and form confluent plaques centrally with a reticulated periphery. Skin markings are preserved, or in the neck and axillae, they may be exaggerated. It has been described as keratotic and vertically rippled plaques, and punctate pigmented papillomatosis [3] [4]. Rarely, atrophic macules may also be seen. A fine powdery scale is produced upon scraping of the lesions. Dermoscopy reveals an ill-defined brownish pigmentation, covered with white scales and a pattern labeled "sulci and gyri" [5]. The color of lesions in CARP are characterized by an early erythematous appearance that later evolves into a grayish brown color [6].

CARP lesions initially develop in the skin of epigastric or intermammary region, and over a period of weeks to months spread over the lower abdomen, breast, pubic area, and the flanks. Exceptions to this can occur, as in one case the lesions were confined to the cheeks and in another, they were confined to the pubic area [7] [8]. The mucous membranes are spared but the involvement of the face, proximal extremities, and forehead may be seen [9] [10].

• Amyloidosis

  Other hypothesis include photosensitivity, genetic factor, amyloidosis cutis and endocrinopathy. [ncbi.nlm.nih.gov]

  It must be distinguished from pityriasis versicolor as well as acanthosis nigricans and cutaneous amyloidosis. [eurekamag.com]

• Cough

  There is still a concentrated area of CRP under my breasts (I have a small case of man boobs,,,beer cough cough). However, im not at 3 1/2 weeks and it’s about 90% clear. The same for my back area. This area was the worst. [medhelp.org]

• Arthritis

  Bacterial infection in confluent and reticulated papillomatosis The use of antibiotics in the treatment of confluent and reticulated papillomatosis was introduced after the fortuitous discovery of improvement in a patient who was taking furacycline for arthritis [emedicine.medscape.com]

• Papule

  Teixeira Dermatology Service of Hospital Pedro Hispano Keywords: adolescence, skin diseases, papillomatosis Abstract Introduction: Confluent and reticulated papillomatosis (CRP) of Gougerot and Carteaud is a rare dermatosis characterized by brownish papules [revistas.rcaap.pt]

  The eruption consists confluent, flat, brown papules localized primarily to the intermammary and interscapular regions with subsequent spread to the breast and abdomen; at the periphery, the papules spread out forming a pigmented reticulated pattern. [ncbi.nlm.nih.gov]

  […] reticulated papillomatosis," "CRP", "CARP", "Familial cutaneous papillomatosis," and "Familial occurrence of confluent and reticulated papillomatosis") is an uncommon but distinctive acquired ichthyosiform dermatosis characterized by persistent dark, scaly, papules [en.wikipedia.org]

  Confluent and reticulated papillomatosis typically manifests as multiple 1 to 2mm erythematous papules that become brownish hyperkeratotic 4 to 5mm papules. [histopathology-india.net]

• Hyperpigmentation

  We report three teenaged Caucasian patients with confluent and reticulated papillomatosis whose presentation was atypical due to the absence of hyperpigmentation and presence of a fine white scale. [ncbi.nlm.nih.gov]

  Thus, there is the possibility that the skin hyperpigmentation associated with 15q tetrasomy syndrome is being diagnosed as CRP. [medicaljournals.se]

  Histologic Features A basket-weave horn Papillomatosis of epidermis with deep depressions Thin epidermis and rete ridges Fusion of adjacent rete ridges forming X and Y configurations Slight hyperpigmentation of the basal layer [dxpath.com]

  The rash actually resolved within 2 weeks with only some residual post-inflammatory hyperpigmentation. [theketorash.com]

  CASE STUDY: A healthy 17-year-old boy presents to clinic with a gradually progressive reticulated hyperpigmentation of the chest and back, which has been present for 1 year. It does not itch or hurt and had a gradual onset. [healio.com]

• Skin Disease

  diseases, papillomatosis Abstract Introduction: Confluent and reticulated papillomatosis (CRP) of Gougerot and Carteaud is a rare dermatosis characterized by brownish papules with fine scaling, forming confluent plaques in the center and reticulated [revistas.rcaap.pt]

  Age range was 13-25 years and the skin disease had lasted for 6 months to 3 years. Initially, acanthosis nigricans was suspected in all cases as the skin histology was compatible with that diagnosis. [ncbi.nlm.nih.gov]

  […] demographics of common skin diseases, comparing Caucasian and all skin of color populations. [books.google.com]

  Key Points *Rare *Affects the trunk area *Characterized by dark, scaly papules and plaques Confluent and reticulated papillomatosis of Gougerot and Carteaud, besides being a mouthful to say, is a relatively uncommon skin disease that usually affects young [ozarkderm.com]

  Kindle Price: $3.53 includes VAT* Similar books to Dermatology: Confluent and Reticulated Papillomatosis (Skin Diseases Book 40) Enter your mobile number or email address below and we'll send you a link to download the free Kindle App. [amazon.com]

The diagnostic criteria for CARP is proposed as:

1. Scaly brown macules and patches. Some appearing papillomatous and reticulated.
2. Involvement of the neck, upper trunk, or flexural areas.
3. No response to antifungal therapy, or negative fungal staining.
4. A favorable response to antibiotics.

On potassium hydroxide (KOH) test, pityrosporum ovale or pityrosporum orbiculare spores and rarely hyphae may be found. A fungal culture may also reveal these microorganisms in some cases. On wood lamp examination, yellow fluorescence can occur if pityrosporum organisms are present. Electron microscopy can help detect alterations in the structure and arrangement of cornified cells in some lesions. An increase may be observed in transitional cell layer, the number of melanosomes in the stratum corneum, and the number of lamellar bodies in the stratum granulosum [11]. On immunohistochemical analysis, suprabasal keratin 16 expression and an intense focal staining in the stratum granulosum are revealed, with an increased number of epidermal cells with Ki-67 binding in the stratum malpighii.

Histopathological features of CARP include:

1. Basket-weave hyperkeratosis.
2. Papillomatosis.
3. Focal acanthosis (limited to areas of rete pegs elongation).
4. Raised basal melanin pigmentation.

• Malassezia Furfur

  Confluent and reticulated papillomatosis (CRP) is a rare dermatosis of unknown aetiology whose relationship to Malassezia furfur is still debated. [ncbi.nlm.nih.gov]

  […] con·flu·ent and re·tic·u·late pap·il·lo·ma·to·sis discrete and confluent gray-brown papules of the anterior and posterior mid-chest, spreading gradually; Malassezia furfur has been found in the keratin layer. [medical-dictionary.thefreedictionary.com]

  Though the exact etiopathogenesis is not known, many theories were proposed regarding obesity, defective keratinisation, exposure to uv light, endocrine imbalance & abnormal host response to malassezia furfur, recently it was proposed that it is probably [jemds.com]

Although a variety of treatments for CARP exist, oral minocycline 50-100mg twice daily has been the preferred treatment. [ncbi.nlm.nih.gov]

Although a variety of treatments for CARP exist, oral minocycline 50–100mg twice daily has been the preferred treatment. [doi.org]

Minocycline was first used for the treatment of CRP in 1965 by Carteaud. [ijdvl.com]

She was initially treated with minocycline, suspended after completing the recommended treatment time. Then, the lesions began to return and oral isotretinoin was started with lesions resolution. [revistas.rcaap.pt]

(Outcomes/Resolutions) The prognosis of Confluent and Reticulated Papillomatosis is good with adequate treatment. [dovemed.com]

Prognosis CRP usually responds to minocycline and azithromycin as first-line drugs, with remission being sustained for years. Recurrences are more common in those treated with other agents, occurring in up to 15 percent of such patients. [news-medical.net]

However, given the superior safety profile of minocycline and azithromycin, systemic retinoids are typically reserved for nonresponders to antibiotics.28 Prognosis The prognosis of CRP is good with marked response (>50% improvement) when minocycline or [dovepress.com]

However, given the superior safety profile of minocycline and azithromycin, systemic retinoids are typically reserved for nonresponders to antibiotics. 28 Prognosis The prognosis of CRP is good with marked response (>50% improvement) when minocycline [ncbi.nlm.nih.gov]

In one study of 10 Lebanese cases, the mean age at diagnosis was 19 years. [8] Prognosis Confluent and reticulated papillomatosis is a chronic disease characterized by exacerbations and remissions. [emedicine.medscape.com]

The etiology is probably multifactorial, so there are several therapeutic options. References González MC et al. Papilomatosis reticulada e confluente de Gougerot-Carteaud. An Pediatr (Barc.) 2008; 68(6): 650-65. Ferreira LM, Diniz LM, Ferreira CJM. [revistas.rcaap.pt]

Of unknown etiology, the condition is characterised by oval grayish-brown or erythematous papules that coalesce to form a reticular pattern, usually on the trunk, especially in the intermammary or interscapular region and on the neck. [ncbi.nlm.nih.gov]

Amyloidosis of the skin has also been proposed as an etiological agent. Genetic Causes While most cases of CRP are sporadic, some familial cases have been reported. [news-medical.net]

Our review of the literature on confluent and reticulated papillomatosis refutes previously accepted epidemiologic data. [ncbi.nlm.nih.gov]

Confluent and reticulated papillomatosis: response to high-dose oral isotretinoin therapy and reassessment of epidemiologic data. J Am Acad Dermatol 1994; 31: 327-331 Paul HB, Loretta SD. [medigraphic.com]

This report defines the prevalence of genital colonization in a large population of women, characterizes the women with S. aureus, and describes epidemiologic features of genital carriage. ‎ Página 50 - Lautenschlager S, Eichmann A. [books.google.es]

This is the first electron microscopic report on CRP suggesting that the pathophysiology of this disease is related to abnormal keratinocyte differentiation. [ncbi.nlm.nih.gov]

To the best of our knowledge, her transient post-partum clearance has not been reported anywhere else in the literature and we believe it may offer a clue in the pathophysiologic process of CARP. [consultant360.com]

The macrolides, on the other hand, regulate immune activation via IL-8 suppression and preventing the neutrophil oxidative burst. [news-medical.net]

General skin care is advised by most healthcare providers typically as a preventive measure for any skin condition. [dovemed.com]

Atlanta: Centers for Disease Control and Prevention, September 1995. ‎ Página 51 - Stone KM, Reiff-Eldridge R, White AD, Cordero JF, Brown Z, Alexander ER, Andrews EB. [books.google.es]

Minocycline inhibits migration of neutrophils. prevents release of reactive oxygen species& inhibits matrix-metalloproteinase. (10)(11)(12) in both cases lesions were completely cleared in 3 weeks suggesting that the bacterial infection might be the cause [jemds.com]

Author Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public [emedicine.staging.medscape.com]

1. Gougerot H, Carteaud A. Papillomatose pigmentée innominée. Bull Soc Fr Dermatol Syphil. 1927;34(Nov 10):719-721.
2. Tamraz H, Raffoul M, Kurban M, Kibbi AG, Abbas O. Confluent and reticulated papillomatosis: clinical and histopathological study of 10 cases from Lebanon. J Eur Acad Dermatol Venereol. 2013;27(1):e119-23.
3. Min ZS, Tan C, Xu P, Zhu WY. Confluent and reticulated papillomatosis manifested as vertically rippled and keratotic plaques. Postepy Dermatol Alergol. 2014;31(5):335-7.
4. Ibekwe PU, Ukonu BA. Punctate, pigmented, and verrucous papillomatosis: a rare variant of Gougerot-Carteaud syndrome. Int J Dermatol. 2016;55(7):806-808. doi: 10.1111/ijd.13097.
5. Bernardes Filho F, Quaresma MV, Rezende FC, Kac BK, Nery JA, Azulay-Abulafia L. Confluent and reticulate papillomatosis of Gougerot-Carteaud and obesity: dermoscopic findings. An Bras Dermatol. 2014;89(3):507-9.
6. Bhagwat PV, Tophakhane RS, Shashikumar BM, Noronha TM, Naidu V. Three cases of Dowling Degos disease in two families. Indian J Dermatol Venereol Leprol. 2009;75(4):398-400.
7. Faergemann J, Fredriksson T, Nathorst-Windahl G. One case of confluent and reticulate papillomatosis (Gougerot-Carteaud). Acta Derm Venereol. 1980;60(3):269-71.
8. Broberg A, Faergemann J. A case of confluent and reticulate papillomatosis (Gougerot-Carteaud) with an unusual location. Acta Derm Venereol. 1988;68(2):158-60.
9. Lee D, Cho KJ, Hong SK, Seo JK, Hwang SW, Sung HS. Two cases of confluent and reticulated papillomatosis with an unusual location. Acta Derm Venereol. 2009;89(1):84-5.
10. 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(4):251-3.
11. Jimbow M, Talpash O, Jimbow K. Confluent and reticulated papillomatosis: clinical, light and electron microscopic studies. Int J Dermatol. 1992;31(7):480-3.