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Year : 1990  |  Volume : 56  |  Issue : 1  |  Page : 48-49

Confluent and reticulate papillomatosis

Correspondence Address:
M P Binitha

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A 40 year old man developed brown, flat-topped warty papules on the upper trunk with confluence of the lesions in some sites. The lesions showed involution with topical applications of 1% clotrima zole cream.

Keywords: Confluent reticulate papillomatosis

How to cite this article:
Binitha M P, Nair V L, Lilly M, Gopinath T. Confluent and reticulate papillomatosis. Indian J Dermatol Venereol Leprol 1990;56:48-9

How to cite this URL:
Binitha M P, Nair V L, Lilly M, Gopinath T. Confluent and reticulate papillomatosis. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 Aug 11];56:48-9. Available from:

Confluent and reticulate papillomatosis (CRP) or Gougerot Carteaud syndrome, is a rare, genetically determined defect of keratini­sation. It is characterised by persistent, asymp­tomatic, papulo-verrucous lesions of characteri­stic distribution, that have a tendency to become confluent and produce a reticulated pattern. Synonyms include nummular and confluent papillomatosis and papillomatose pigment 'ee coniluente et reticul'ee innomin'ee.[1] CRP occurs mainly in girls and begins at or soon after puberty. We are reporting a case of CRP of relatively late onset in a male patient.

  Case Report Top

A 40-year-old man employed in the Middle East came with mildy itchy, brownish papular lesions aggravated on sweating, on the upper trunk, since 2 years. The lesions first appeared on the middle of the chest and back as light brown spots, and gradually became warty. These spread onto the shoulders and abdomen. He was treated with 11% o econazole nitrate cream with temporary relief. There was no family history of similar illness.

He was an obese man. The lesions were well defined, brown, slightly elevated, flat-topped, warty papules 1-4 mm in size on the upper back, shoulders, interscapular and intermammary areas. A few scattered lesions were present on the abdomen. The papules on the upper back were confluent, but most of the lesions were discrete. Microscopic examination of the scrapings in 10% KOH did not show any filaments or spores of Malassezia fitrfur.

Biopsy of a lesion showed hyperkeratosis, thinning of the granular layer and papillomatosis. There was vascular dilatation in the upper dermis, moderate oedema and a scanty perivas­cular lymphocytic infiltrate.

He was treated with I % clotrimazole cream twice daily. The lesions cleared partially in a fortnight. He was lost to further follow up, as he left India.

  Comments Top

The first case of this disorder was presented by Gougerot and Carteaud in 1927 under the name of Papillomatose pigmentee innominee.[1] In 1932, they classified the cutaneous papillo­matoses into three groups : (a) punctate, pig­mented and verrucose papillomatosis; (b) con­fluent and reticulated papillomatosis; (c) nummu­lar and confluent papillomatosis.[1]

Very few cases have been reported from India.[2],[3],[4] Most of the reported cases are in Negroes[5] Occurrence of CRP in members of the same family suggests that it is possibly an inherited disorder.[6] As most cases are sporadic, it was suggested that there may be an inherited and an acquired form. Most cases reported were stocky and obese.[7] CRP affects both sexes but two thirds of the patients are women.

The onset, distribution and pigmentary disturbance suggest a close similarity to pityriasis versicolor, but examination of the scrapings from the lesions do not demonstrate Pityrosporurn orbiculare (Malassezia furfur). However, treat­ment with local applications effective against P. orbiculare produces clearing of the eruption. Therefore, the underlying defect may be an abnormality of the host response to colonisation by P. orbiculare.[8] Association of CRP with pseudoatrophoderma colli and acanthosis nigricans has been reported.[5] It was speculated that these three conditions belong to a group of persistent asymptomatic pigmentary disorders.[5]

  References Top

1.Waisman M : Cutaneous papillomatosis, in Clinical Dermatology, Editor, Demis DJ Harper and Row Publishers, Philadelphia, 1985; Vol 1, Unit 1-42, : pp 1-5.  Back to cited text no. 1    
2.Yesudian P, Kamalam S and Razack A : Confluent and reticulated papillomatosis (Gougerot­ Carteaud) : Abnormal host reaction to Malassezia furfur, Acta Dermato-Venereol, 1973; 53 : 381.  Back to cited text no. 2    
3.Pavithran K : Confluent and reticulate papilloma­tosis, Ind J Dermatol Venereol Leprol, 1982; 48 : 45-48.  Back to cited text no. 3    
4.Rajendran N : Confluent and reticulate papilloma­tosis, Ind J Dermatol Venereol Leprol, 1989; 55; 51-52.  Back to cited text no. 4    
5.Kesten BM and James HD : Pseudoatrophoderma colli, acanthosis nigricans and confluent and reticulate papillomatosis, Arch Dermatol. 1957; 75 : 525-542.  Back to cited text no. 5    
6.Baden MP : Familial cutaneous papillomatosis, Arch Dermatol, 1965; 92 : 394-395.  Back to cited text no. 6    
7.Watkins DM and Lockwood JH : Confluent and reticulated papillomatosis, Arch Dermatol, 1957; 76 : 648-651.  Back to cited text no. 7    
8.Roberts SOB and Lachapelle JM : Confluent and reticulate papillomatosis and Pityrosporunr orbicu­lare, Brit J Dermatol, 1969; 81 : 841-845.  Back to cited text no. 8    


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