Gougerot and Carteaud’s CRP is an out-of-ordinary dermatosis typically observed in adolescents. Clinically, this condition features enduring pigmented lesions and textured macules, papules, patches or plaques. The dermatological lesions typically exhibit confluence at the central region and a grid-like pattern towards the margins. Moreover, these eruptions commonly occur in areas including the cervical region, the space between the shoulder blades, the regions between the breasts and the axillary regions.
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CRP’s precise cause remains elusive; however existing literature proposes a potential association with aberrant excessive keratinization of the epidermis in conjunction with an inherent propensity for a heightened proliferative reaction to colonization by M furfur.
5 In recent studies, the identification of Dietzia spp. on the epidermis has emerged as a potential contributor to the etiology of CRP. Additional potential contributors to CRP encompass endocrine dysregulations including insulin resistance and hypothyroidism, sensitivity to UV light, a form of cutaneous amyloidosis and genetic predisposition.
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CRP is frequently clinically misdiagnosed as pityriasis versicolor and typically does not respond to antifungal medications.
6 In the past, CRP was considered a clinical form of AN but these two differ in appearance because AN has a lighter on its lesions.
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Seongmoon Jo et al
6,7 proposed an update to the original criteria proposed as follows:
(1) Clinical manifestation featuring appearance of scaly brown macules and patches with some exhibiting a mesh-like reticulate macules and wart-like (papillomatous) nature.
(2) Predominantly affecting Upper torso and cervical region or skin flexural folds.
(3) Negative fungal staining of scales;
(4) excellent response to antibiotic treatment.
Multiple treatment options are currently available for Gougerot and Carteaud’s CRP, among which Minocycline has been recommended as the most effective treatment probably due to its anti-inflammatory, immunosuppressive and anti-proliferative properties.
8 More recent reports support that various oral antibiotics including azithromycin, clarithromycin and tetracyclines also have been successful in treating CRP. The effect of antibiotics might be predominantly anti-inflammatory; however, no bacteria, even in the role of colonizers, were identified in the lesion sites or biopsied specimen before. The debate on the etiology of CRP has lasted for decades and continues without a definite conclusion. The frequent onset of CRP in adolescents or young adults, the occasional association with obesity and the predilection for the seborrheic areas of the trunk suggest an association with sebum production or an alteration of sebum by resident bacteria. Minocycline is effective in ameliorating acne, in part, by inhibiting the growth of Propionibacterium acnes, a normal inhabitant of skin. It may be that CRP represents an abnormal host response to P. acnes or other resident flora and that the effectiveness of minocycline in CRP stems from its antibiotic properties.
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In pediatrics the initial dose of minocycline is usually 4 milligram (mg) per kilogram (kg) of body weight followed by 2 mg per kg of body weight every 12 hours during 6 to 10 weeks.
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Additionally, alternative, but less effective, oral treatment options for CRP such as isotretinoin, acitretin and etretinate are available. In addition, multiple topical agents including tacalcitol, selenium sulfide, ketoconazole cream, tretinoin, tazarotene and calcipotriene (calcipotriol) have also been used.
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The authors highlight this clinical event of a 16-year-old obese female presenting numerous pigmented papillomatous asymptomatic dermal irregularities, misdiagnosed as AN for 2 years, in which the oral administration of minocycline on doses of 50-100 mg on a twice a day regime, resulted in considerable regression of the skin abnormalities after 1 month.
CRP represents an infrequent dermatosis characterized by a persistent and recurring nature, predominantly observed among adolescents. The cause of CRP remains a topic of debate; however, it is widely acknowledged as a condition linked to irregularities in keratinization. Its morphological similarity to AN and pityriasis versicolor often leads to misdiagnosis and mistreatment, causing significant social discomfort for the affected individuals. Minocycline continues to stand as the primary treatment for this condition due to its favorable patient response and minimal occurrence of side effects.
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- Scheinfeld N. Confluent and reticulated papillomatosis: a review of the literature. Am J Clin Dermatol 2006;7(5):305-313.
- Yesudian P, Kamalam S, Razack A. Confluent and reticulated papillomatosis (Gougerot-Carteaud). An abnormal host reaction to Malassezzia furfur. Acta Derm Venereol 1973;53(5):381-384.
- Sudy E, Urbina F, Gubelin W, Misad C, Espinoza A. Pseudoatrophoderma colli: distinct entity or just a variant of confluent and reticular papilomatosis of Gougerot-Carteaud. Dermatol Online J 2020 Oct 15;26(10):1-9.
- Rao T, Guruprasad P, Sowjanya C, Nagasridevi I. Confluent and reticulated papillomatosis: successful treatment with minocycline. Indian J Dermatol Venereol Leprol 2010;76(6):725.
- 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 Apr;148(4):505-508.
- Jo S, Park HS, Cho S, Yoon H. Updated diagnosis criteria for confluent and reticulated papillomatosis: a case report. Ann Dermatol 2014 Jun;26(3):409-410.
- Davis MDP, 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 Feb;154(2):287-293.
- Montemarano A, Andrew D, et al. Confluent and reticulated papillomatosis: response to minocycline. Journal of the American Academy of Dermatology, 1996, 34.2: 253-256.
- Humbert P, Treffel P, et al. The tetracyclines in dermatology. Journal of the American Academy of Dermatology, 1991, 25.4: 691-697.
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