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| LETTERS TO EDITOR |
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| Year : 2016 | Volume
: 17
| Issue : 3 | Page : 245-246 |
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Hypopigmented variant of confluent and reticulated papillomatosis
Sahana M Srinivas
Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| Date of Web Publication | 5-Jul-2016 |
Correspondence Address:
Sahana M Srinivas
Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2319-7250.179488
How to cite this article:
Srinivas SM. Hypopigmented variant of confluent and reticulated papillomatosis. Indian J Paediatr Dermatol 2016;17:245-6 |
Sir,
Confluent and reticulated papillomatosis (CARP) of Gougerot and Carteaud is a rare disorder of unknown etiology. It is characterized by hyperkeratotic light to grayish brown papules that coalesce into plaque with a reticulated periphery.[1] Hypopigmented variant is rarely seen. CARP usually presents on the central trunk and is seen more commonly in young adults between the age group of 10–35 years. We describe this hypopigmented type of CARP in an 11-year-old male child.
An 11-year-old healthy boy presented with asymptomatic skin lesions on chest and back from past 8 years. Initially started as hypopigmented macules on the chest at the age of 3 years and slowly progressed to involve the entire chest, lower abdomen, and back. He was diagnosed as having fungal infection and treated with topical and oral antifungals with no improvement. Past history and personal history were nonsignificant. General physical examination was normal. Cutaneous examination showed multiple hypopigmented confluent macules and flat-topped hyperkeratotic papules coalesced to form plaques present on the chest, and back in a reticular pattern [Figure 1]a and [Figure 1]b. Few depigmented macules present on back. Systemic examination was normal. Complete blood count and serum chemistry profile were normal. Skin scrapings for potassium hydroxide examination were negative. Skin biopsy from the papule showed acanthosis, papillomatosis, with mild perivascular lymphocytic infiltrate in the dermis [Figure 2]. Based on the above findings, diagnosis of hypopigmented variant of CARP was done. Child was started on oral minocycline 100 mg twice/day, with few lesions flattening after 1 month of treatment. Child is on regular follow-up. | Figure 1: (a and b) Multiple hypopigmented confluent macules and plaques present on the chest and back in a reticular pattern
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 | Figure 2: Epidermis showing acanthosis, papillomatosis, with mild perivascular lymphocytic infiltrate in dermis (H and E, ×40)
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The initial diagnostic criteria for CARP proposed by Davis et al.,[2] include (a) clinical findings of scaling brown macules and patches, some reticulated and papillomatosis, (b) location on upper trunk and neck, (c) fungal staining of scale negative for spores and hyphae, (d) lack of response to antifungals, and (e) excellent response to minocycline. CARP clinically presents as red to brown papules which later becomes hyperkeratotic and verrucous. It spreads centrifugally with confluent lesions at center and reticulated at the periphery. Atypical variants include atrophic macules, rippled reticulated erythema, or hypopigmented macules or papules.[3] Common sites of predilection include inframammary area, breasts, axillae, neck, abdomen, interscapular area, and inguinal region. Other sites rarely involved are knees, elbows, antecubital, and popliteal fossae. Our case had met all the diagnostic criteria except the hypopigmented nature of the lesion. Hudacek et al. have described 4 cases of CARP with unusual presentation of hypopigmented lesions.[4] Among the four cases, two cases were children.
The etiology and pathogenesis of CARP are exactly not known. Different theories described in literature include hereditary predisposition, exposure to ultraviolet rays, endocrine imbalance, disturbance of keratinization, and infection with pityrosporum ovale.[5] The hypopigmentation in our case could be due to the association of pityrosporum ovale or alteration in melanin synthesis but still remains unclear. Differential diagnosis of hypopigmented variant includes tinea vesicular, postinflammatory hypopigmentation, trichrome vitiligo, and progressive macular hypomelanoses. The characteristic clinical presentation of CARP can exclude other differential diagnosis.
The treatment of choice in CARP is oral minocycline 50–100 mg twice daily for 6 weeks. Other treatment modalities include topical retinoids, tazarotene, and oral isotretinoin showing good improvement.[3],[4] A high index of suspicion is required when a child presents with persistent hypopigmented papules in a characteristic distribution as prolonged treatment is necessary for hypopigmented CARP.
Acknowledgment
The author would like to thank Dr. Madhavi Naik, Consultant Pathologist, St Theresa's Hospital, Bengaluru, India.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Scheinfeld N. Confluent and reticulated papillomatosis: A review of the literature. Am J Clin Dermatol 2006;7:305-13.  |
| 2. | 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;154:287-93. |
| 3. | Min ZS, Tan C, Xu P, Zhu WY. Confluent and reticulated papillomatosis manifested as vertically rippled and keratotic plaques. Postepy Dermatol Alergol 2014;31:335-7. |
| 4. | Hudacek KD, Haque MS, Hochberg AL, Cusack CA, Chung CL. An unusual variant of confluent and reticulated papillomatosis masquerading as tinea versicolor. Arch Dermatol 2012;148:505-8. |
| 5. | 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:e119-23. |
[Figure 1], [Figure 2]
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