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Confluent and Reticulated Papillomatosis

Last updated Feb. 13, 2021

Reviewed by: Lester Fahrner, MD

Approved by: Krish Tangella MD, MBA, FCAP

Confluent and Reticulated Papillomatosis (CRP) is a rare condition of the skin characterized by chronic scaling, brown patches and plaques that affect the neck and upper trunk.

What are the other Names for this Condition? (Also known as/Synonyms)

  • CRP (Confluent and Reticulated Papillomatosis)
  • Gougerot-Carteaud Syndrome

What is Confluent and Reticulated Papillomatosis? (Definition/Background Information)

  • Confluent and Reticulated Papillomatosis (CRP) is a condition of the skin characterized by chronic scaling, brown patches, and plaques that affect the neck and upper trunk
  • No risk factors for Confluent and Reticulated Papillomatosis have been identified. The condition is mostly seen in older children, teens, and young adults
  • The exact cause of this condition is also unknown. However, several potential causes, such as hormonal imbalance and bacterial infections, have been proposed to explain Confluent and Reticulated Papillomatosis
  • A healthcare provider typically diagnoses Confluent and Reticulated Papillomatosis by identifying the histological appearance of the skin scales, while ruling out other conditions
  • The prognosis of the disorder is good, with appropriate topical and/or antimicrobial treatment. Nevertheless, Confluent and Reticulated Papillomatosis is known to recur in some cases

Who gets Confluent and Reticulated Papillomatosis? (Age and Sex Distribution)

  • Although, Confluent and Reticulated Papillomatosis can occur at any age, the mean age of incidence of CRP is stated to be between 15 and 29 years
  • Both genders may be affected by CRP, with a higher incidence being reported among females 
  • Individuals of all races and ethnic groups are susceptible to CRP. However, the disorder occurs in a higher frequency among Caucasians and Indians

What are the Risk Factors for Confluent and Reticulated Papillomatosis? (Predisposing Factors)

  • There are no known risk factors of Confluent and Reticulated Papillomatosis, as the cause of the condition has not been determined
  • A higher incidence of CRP is reported among people of Caucasian or Indian descent

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Confluent and Reticulated Papillomatosis? (Etiology)

The exact cause of Confluent and Reticulated Papillomatosis is unknown. But, the following theories have been proposed as probable causes for the condition:

  • Bacterial infection is one of the most popular theories proposed, due to many CRP cases responding well to anti-bacterial treatment
  • Hormonal imbalances have been explored as a cause due to the common appearance of elevated insulin levels or insulin resistance in CRP
  • Some researchers believe that disordered keratinocyte differentiation and maturation may result in the condition. This theory is supported by the observation that individuals with CRP respond well to medications that arrest cell growth
    • Keratins are proteins that give the skin its structural integrity
    • Keratinocytes are cells that produce keratin
  • Yeast infections, since Malassezia spp. (a type of yeast) have been reported in some affected individuals, who have had favorable outcomes with antifungal medication. These yeasts, previously known by the name Pityrosporum spp, are found normally on the skin in post-pubertal individuals. In some conditions, they appear to over proliferate
  • Overexposure to ultraviolet (UV) light has occasionally resulted in the appearance of CRP
  • Hereditary roots have been suggested due to familial incidence of CRP (more than one family member affected by the condition)

What are the Signs and Symptoms of Confluent and Reticulated Papillomatosis?

The signs and symptoms of Confluent and Reticulated Papillomatosis are generally limited to the skin. There are no systemic symptoms. The hallmark signs and symptoms on skin include:

  • Papules (small raised pimples) and plaques (elevated/depressed discolored sections of skin) that are merged together (confluent) and organized in a network or reticulate pattern
  • Papule hyperpigmentation (browning of papule skin surface)
  • Papule localization to the upper trunk, underarm, and neck
  • White papule scaling

How is Confluent and Reticulated Papillomatosis Diagnosed?

The diagnosis of Confluent and Reticulated Papillomatosis is made by the following tools:

  • A complete physical examination and an assessment of symptoms
  • Evaluation of the affected individual’s medical history
  • Examination of the affected area for the clinical and histological characteristics of CRP, which may include:
    • Scaly brown patches and papillae
    • Upper trunk and neck involvement
    • Negative tests for the presence of fungus and a corresponding lack of change in response to antifungal treatment
    • Response to antibiotic treatment

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Confluent and Reticulated Papillomatosis?

There are no systemic complications of Confluent and Reticulated Papillomatosis.

  • Some individuals may undergo severe emotional stress due to cosmetic concerns
  • It is possible for the condition to recur after treatment, if the underlying (unknown) cause has not been resolved. Recurrence is most commonly observed when the treatment does not involve antibiotics

How is Confluent and Reticulated Papillomatosis Treated?

The treatment of Confluent and Reticulated Papillomatosis (CRP) targets the symptoms and possible causes. The treatment measures may include:

  • Administration of antibiotics which target bacteria, often believed to be the underlying cause of many cases of CRP. It may be that the antibiotics work because of anti-inflammatory or other non-bactericidal properties
  • Use of antifungal medications which have had historical success in treatment. It has been recently hypothesized that certain extraneous properties of antifungal treatments have been the cause of their success, rather than the antifungal action in itself
  • Topical retinoids that affect keratinocyte differentiation and adhesion
  • Systemic retinoids (often in pill form), which also affect keratinocyte adhesion and differentiation

How can Confluent and Reticulated Papillomatosis be Prevented?

Currently, there are no guidelines for the prevention of Confluent and Reticulated Papillomatosis, since the exact cause of CRP is not known.

  • General skin care is advised by most healthcare providers typically as a preventive measure for any skin condition. Such skin care measures include hydration, sanitation, and UV ray protection
  • Active research is currently being performed to explore the possibilities for treatment and prevention of disorders such as CRP
  • Regular medical screening at periodic intervals with tests and physical examinations are recommended

What is the Prognosis of Confluent and Reticulated Papillomatosis? (Outcomes/Resolutions)

  • The prognosis of Confluent and Reticulated Papillomatosis is good with adequate treatment. The condition often gets resolved and does not recur
  • Occasionally, CRP has required repeat treatment due to recurrence
  • Spontaneous resolution of CRP has been observed on extremely rare occasions

Additional and Relevant Useful Information for Confluent and Reticulated Papillomatosis:

Though no definitive cause has been identified, recurrence of Confluent and Reticulate Papillomatosis has been observed in patients who did not initially use antibacterial therapy.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: July 25, 2017
Last updated: Feb. 13, 2021