DOI: 10.14260/jemds/2015/684

case report

CONFLUENT AND RETICULATE PAPILLOMATOSIS: A REPORT OF TWO CASES

R. Rama1, B.Indira2, P. Guru Prasad3,S. Jhansi Lakshmi4, Shravya5

HOWTOCITETHISARTICLE:

R. Rama, B. Indira, P. Guru Prasad, S. Jhansi Lakshmi, Shravya.“Confluent and Reticulate Papillomatosis: A Report of Two Cases”.JournalofEvolutionofMedicalandDentalSciences2015;Vol.4,Issue27,April 02;

Page:4722-4725,DOI:10.14260/jemds/2015/684

ABSTRACT: confluentandreticulatepapillomatosiswasfirstdescribedin1927byGougerot-Carteaud(C.R.P).itisanuncommondermatosesaffectingyoungindividualscharacterisedbyassymptomaticmultiplebrownishscalypapulescoalescedtoformreticularpatternperipherallyandconfluentplaquescentrallyininter-mammary,inter-scapularareas,shoulderarms.DiseasebeginsinlateteenshavesexdistributionaffectswhiteblacksAsianpatients. Thoughtheexactetiopathogenesisisnotknown,manytheorieswereproposedregardingobesity,defectivekeratinisation,exposuretoUV-light,endocrineimbalanceabnormalhostresponsetomalasseziafurfur,recentlyitwasproposedthatitisprobablyareactionpatterntobacterialinfectioninsusceptibleindividualsresultinginepidermalproliferation.MinocyclineisagoodchoiceforC.R.P. herewereport2casesofC.R.P.respondingwelltominocycline.

Keywords:Confluentreticulatepapillomatosis,minocycline.

Case report:

Patient-1:A36yearsoldmalepatientwaspresentedtoourdermatologydepartmentwithitchyreddishbrownpapularlesionsontheuppertrunknecksince1yearduration.Thelesionsinitiallyappearedonintermammary&interscapularareas, laterspreadtotheupperarms&neck.Heusedtopicalketoconazolepreparationbuttherewasnoimprovement.Hedeniedfamilyhistoryofsimilarlesionsandtherewerenoothercomplaints.

Onexaminationhisgeneralconditionwasgood,obese.cutaneousexaminationthelesionswerewell-defined,reddishbrown,multiplewartypapulesof2-4mminsizeontheintermammary,interscapularareas,upperarmsneck.thelesionsontheupperbackwereconfluentcentrallyperipherallyinareticulatedpattern. (fig.12).

microscopicexaminationofscrapingsin10%kohwetmountdidnotshowanyfilamentsorsporesofmalasseziafurfur. histopathologicalexamination(fig. 34)ofskinbiopsyshowedhyperkeratosis,acanthosis,papillomatosisincreasedpigmentationinthebasallayer.basementmembraneisintact.thereismildperivascularlymphocyticinfiltrates,melanophagesintheupperdermis.basingonhistory,clinicalexamination&biopsyfindingsadiagnosisofconfluentandreticulatepapillomatosiswasmade.

Patient-2: A22yearoldmalepatientpresentedwith1yearhistoryofreticularpigmentedlesionsontrunkbothupperlowerlimbs.therewashistoryofseborrhoea.Hedeniesfamilyhistoryofsimilarlesionstherewerenoothercomplaints.Onexaminationhehadreddishbrownreticularpigmentedlesionsonbothupperlimbsmoresooverrightforearmthenontheleftside.Scalingispresentinsomeareas.Hyperpigmentedscalymacularlesionspresentonfrontofchestupperback.10%kohwetmountexaminationshowednofungalelements.

Onhistopathologicalexaminationepidermisshowsmildhyperkeratosis,focalparakeratosis,mildhypergranulosisandacanthosis.basallayerisintact.upperdermisshowsproliferativethinwalledvessels,perivascularedemamildlymphocyticinfiltrate. Basedonhistory,clinicalexamination,histopathologicalexaminationadiagnosisofconfluentreticulatepapillomatosiswasmade.

Discussion: CRPisraregeneticallydetermineddefectofkeratinisationcharacterisedbypersistentasymptomaticwartypapularlesionsofcharacteristicdistributionwithtendencytobecomeconfluentcentrallyperipheralreticulatedpattern.(1)Thoughtheetiopathogenesisisstillnotpreciselyknown,occurenceofC.R.Pinfamilymemberssuggestgeneticfactors.(2),(3)mostofthecasesareobese.(4)C.R.Paffectsboththesexesequally.inthisreport2casesaremalesbothdeniedhistoryofsimilarcomplaintsinthefamily.Previouscasereportssuggestthatthereisabnormalityofthehostresponsetocolonisationbymalasseziafurfur.(5)Above2casesdidnotshowanyfungalfilamentsorspores.insomereportsactinomyceteisisolatedfromtheskinofanimmmunocompetentpatientswithCRP.(6),(7)

thoughoralazithromycinissuccessful(8)minocyclineishighlyeffectiveinmostofthepatients.(9)minocyclinepossessbothanti-inflammmatoryanti-microbialproperty.Buttheresponsetothesespecificantibioticmayberelatedmoretotheiranti-inflammmatorypropertiesratherthananti-microbialeffect.Minocyclineinhibitsmigrationofneutrophils.preventsreleaseofreactiveoxygenspecies&inhibitsmatrix-metalloproteinase.(10)(11)(12)inbothcaseslesionswerecompletelyclearedin3weekssuggestingthatthebacterialinfectionmightbethecause.henceminocyclineiseffectiveinhealingthesecondition.

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  9. Davis MD. Weening RH Camilleri MJ: confluentreticulate papillomatosis (gongeroutcastaend syndrome)a minocycline responsive dermatosis without evidence for yeast in pathogenesis. A study of 39 patients and a proposal diagnostic criteria Br.J.dermatol 2006.154:287-93.
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  12. Tugenyu,yicao,xiaohongyanget al- two cases of C.R.P successfully treated with Chinese drug I.J.D 2009.VOLUME 54.ISSUE 5.PAGE 60-62.

J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol.4/ Issue 27/ Apr 02, 2015 Page 1