Conjluent and reticulate papillomatosis (Gougerot-Carteaud) 
Conjluent and reticzilate papillomatosis 
(Gougerot-Carteaud) 
R. Fink-Puches, J. Smolle and HP. Soyer 
SUMMARY 
A 17 year-old girl with the diagnosis of confluent and reticulate papillomatosis (CRP) is presented. 
Clinical and histiopathologic differential diagnostic considerations as well as the pathogenesis of 
CRP are discussed. 
Introduction 
Confluent ancl reticulate papillomatosis (CRP) was 
first clescribecl by Gougerot ancl Carteaucl in 1927 (1). It 
consists of grayish-brown pigmentecl papules that later 
coalesce, most often localizecl in the intermammary ancl 
interscapular regions, neck ancl abdomen. It usually 
starts after puberty, primarily in females (2). The etiology 
remains unclear but many observations are in favor of 
the role of Pityrosporum orbiculare in CRP (3). A case 
of confluent ancl reticulatecl papillomatosis responcling 
to treatment with minocycline is reportecl. 
Case report 
A 17-year-old girl with asymptomatic, brownish, 
papules that coalesced into sharply circumscribed 
plaques in the nuchal ancl interscapular region was 
admitted to our Department (Figure 1). Similar skin 
lesions were found to a smaller extent in the sternal 
region. The first clinical cliagnosis was atypical pityriasis 
versicolor; further differential diagnosis included 
acanthosis nigricans. 
Histopathogy of a biopsy specimen from the nuchal 
region showed basket-wave hyperkeratosis, acanthosis 
ancl papillomatosis and a sparse, preclominantly lym-
phocytic infiltrate around the superficial vascular plexus 
(Figure 2a). Closer scrutiny revealecl foci of numerous 
small spores in the cornifiecl layer clearly visible already 
with hematoxylin-eosin staining (Figure 2b). The most 
probable histopathologic diagnosis was seborrhoic 
keratosis; further clifferential cliagnosis consiclerations 
were acanthosis nigricans ancl epiclermal nevus. How-
ever, ali these histopathological differential cliagnoses 
were not consonant with the clinical cliagnosis proviclecl 
on the case report slip, namely, atypical pityriasis versi-
color. 
Further investigations: 
The mycological examination from the nuchal re-
gion revealed numerous spores but no hyphae thus 
Case repo r t 
K E Y 
WORDS 
confluent and 
reticulate 
papillomatosis, 
Pityrosporum 
orbiculare, 
pityriasis 
versicolor, 
tetracyclines 
28 acta dermatovenerologica A.P.A. Vol 8, 99, No 1 
Confluent and reticulate papillomatosis (Gougerot-Carteaud) 
ruling out pityriasis versicolor, because microscopy of 
the scales of pityriasis versicolor always reveals thick-
walled sphe rical yeast forms and coarse septate 
mycelium often broken up into short filaments. Also, 
PAS-staining of the biopsy specimen revealed spores 
but no hyphae within the cornified layer. So, the diag-
nosis confluent and reticulated papillomatosis Gouge-
rot-Carteaud (CRP) was made. 
Previous treatment with antifungal agents was in-
effective. Thus, treatment with minocycline (l00mg/ 
daily) was started. The patient experienced significant 
improvement after 3 weeks and 6 weeks later her skin 
was completely clear. 
Discussion 
The diagnosis of CRP in our patient has been establi-
shed by the typical clinical aspect, namely slightly ve-
rrucous brownish papules and confluent plaques in the 
nuchal and interscapular region in addition to the 
histopathologic findings - basket-wave hyperkeratosis, 
acanthosis and papillomatosis and cluster of spores in 
the cornified layer. So, CRP is a typical example in which 
the definite diagnosis is achieved by clinico-pathologic 
correlation. Based on a review of 48 cases reported in 
the literature from 1978 to 1992 Lee et al. defined CRP 
by the following criteria: i) hyperpigmented papules and 
plaques involving at least the central portion of the chest 
or back with central confluence and peripheral reticu-
lation; ii) no hyphae demonstrable, either by performing 
mycological examination or by conventional light 
microscopy of a biopsy specimen; and iii) basket-wave 
hyperkeratosis, acanthosis and papillomatosis and a 
sparse, superficial perivascular infiltrate histopatho-
logically (4) . 
The most probable clinical diagnosis in our patient 
was pityriasis versicolor. The diagnosis of pityriasis 
versicolor, however, as a rule, is based on the myco-
logical examination revealing spherical, thick-walled 
spores and hyphae that are often fragmented to short 
filaments. Histopathologically, in pityriasis versicolor the 
prominent basket-wave stratum corneum is situated 
above a rather normal epidermis. Also, in pityriasis 
versicolor short hyphae are always present together with 
spores in the cornified layer. Therefore , the clinical 
diagnosis of p ityriasis versicolor in our patient has been 
excluded by the mycological and histopathologic 
examination . 
The exact pathogenesis of CRP remains unknown. 
On the one hand it was thought that CRP represents an 
abnormal bost reaction to Pityrosporum orbiculare 
(ovale) and therefore treatment with topical and sys-
temic antifungal agents is carried out with variable 
success. The mechanism by which the Pityrosporum 
30 
Fig. 1. Confluent and reticulated papillomatosis 
in the nuchal region of a 17-year-old girl. 
Fig. 2a. Hyperkeratosis, acanthosis and 
papillomatosis and a sparse lymphocytic 
infiltrate arround the superficial vascular plexus 
(Hematoxylin-eosin stain< x 100). 
Cas e repo rt 
acta dermatovenerologica A.P.A. Vol 8, 99, No 1 
Ca se r e p o rt 
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Confluent and reticulate papillomatosis (Gougerot-Carteaud) 
yeasts induce the skin changes are not known (3) . Direct 
lipase activity or antibody-mediated epidermal damage 
are discussed. On the other hand CRP is regarded as a 
benign disorder of keratinization and thus drugs with 
an "antikeratinizing effect" such as retinoids have been 
used more or less effectively to clear this condition (5) . 
Our patient was successfully treated with minocycline 
(l00mg/die over 6 weeks) . The basis far the efficacy of 
minocycline is uncertain. This agent is effective against 
gram-positive and gram-negative bacteria and some 
mycobacteria, suggesting that a yet unknown bacterium 
' plays a role in the pathogenesis of CRP. 
Fig. 2b. Small spores in the cornified layer 
(Hematoxylin-eosin stain< x 250) 
REFERENCES 
AUTHORS' 
ADDRESSES 
l. Gougerot H, Carteaud A. Papillomatose pigmentee innominee. Bul! Soc Fr Dermatol Syph 1927; 34: 
719-21. 
2. Broberg A, Faergemann]. A case of confluent and reticulate papillomatosis (Gougerot-Carteaud) with 
an unusual location. Acta Derm Venereol (Stockh) 1987; 68: 158-60. 
3. Faergemann J. Lipophilic yeasts in skin diseases. Semin Dermatol 1985; 4: 173-84. 
4. Lee MP, Stiller MJ, McClain STA, Shupack JL, Cohen DE. Confluent and reticulated papillomatosis: 
Response to high-dose oral isotretinoin therapy and reassessment of epidemiologic data. J Am Acad 
Dermatol 1994; 31: 327-31. 
5. Baalbaki SA, MalakJA, Al-Khars MA. Confluent and reticulated papillomatosis. Treatment with etretinate. 
Arch Dermatol 1993; 129: 961-3 
Regina Fink-Puches, MD, Department oj Dermatology, University oj Graz, 
Auenbruggerplatz 8, A-8036,Austria 
Josej Smolle, MD, associate projessor oj dermatology, same address 
H Peter Soyer, MD, associate projessor oj dermatology, same address 
acta dermatovenerologica A.P.A. Vol 8, 99, No 1 ----- ------------------------- 31