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      Confluent and Reticulated Papillomatosis of Gougerot and Carteaud: A Case Report and Review of the Literature

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          Abstract

          Confluent and reticulated papillomatosis (CARP) of Gougerot and Carteaud is a rare chronic disease with exacerbation and remissions typically affecting young people. Classic clinical characteristics include asymptomatic scaly hyperpigmented macules, patches, and papules in the trunk's confluent and reticular pattern.

          A 12-year-old girl, otherwise healthy, presented with itchy, persistent skin lesions all over her body for one year. Skin examination revealed generalized scaly brownish patches, thin papules, and plaques all over her body, including her face, neck, middle of the chest, abdomen, back, upper extremities, elbows, lower extremities, and knees. Wood's lamp examination of her skin lesions was unrevealing. Skin biopsy showed papillomatosis, hyperkeratosis, acanthosis, and hypergranulosis. The dermis showed perivascular inflammatory cellular infiltrate. Based on the above clinicopathological findings, the patient was diagnosed with CARP. In our case, a generalized form was reported. CARP is diagnosed based on clinical and histopathological features. Oral antibiotics are the cornerstone of treatment. Our patient responded well to oral minocycline 85 mg one tablet daily, tacrolimus 0.1% ointment twice daily, and selenium sulfide shampoo twice weekly for two months.

          The classic clinical characteristics of CARP include asymptomatic scaly hyperpigmented macules, patches, and papules in a confluent and reticular pattern on the trunk. A generalized form, as in our case, has been reported. CARP is diagnosed based on clinical and histopathological features. Oral antibiotics are the cornerstone of treatment.

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          A Review on Pityriasis Rubra Pilaris.

          Pityriasis rubra pilaris (PRP) is an idiopathic, papulosquamous inflammatory dermatosis. It is characterized by hyperkeratotic follicular papules coalescing into orange-red scaly plaques, islands of sparing, and palmoplantar keratoderma. PRP can be subdivided into six clinical subtypes according to Griffiths' classification, based on age of onset, disease extent, prognosis, and other associated features. The sixth subtype of PRP occurs in individuals affected by HIV infection, and retroviral screening in all de novo cases of PRP is advised. Other reported associations include various infections, autoimmunity, drugs, and malignancies, although the true significance of these is still unclear. The genetic basis for familial cases, most commonly categorized under the fifth subtype, has been mapped to gain of function mutations in the caspase recruitment domain family, member 14 (CARD14) gene. Treatment of PRP remains a challenge to this day due to a paucity of high-quality evidence. Therapeutic regimens have been guided mostly by case reports and case series, with the mainstay of treatment being oral retinoids. Recently, biologics have emerged as a promising treatment for PRP. We present a review of the clinicopathologic features, pathogenesis, associated disorders, and treatment of PRP, with an emphasis and critical appraisal of the existing literature on the latter.
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            Confluent and reticulated papillomatosis : a review of the literature.

            Confluent and reticulated papillomatosis (CARP) was first described >60 years ago. It is distinct from acanthosis nigricans. This article presents the results of a review of the literature in MEDLINE through May 2006 using the terms 'confluent and reticulated papillomatosis', 'reticulated and confluent papillomatosis of Gougerot and Carteaud', and 'reticulated papillomatosis'. A recent report has linked the presence of Dietzia spp. (family: Dietziaceae; suborder: Corynebacterineae; order: Actinomycetales) in the skin to CARP. CARP has also been linked to defects in keratinization. Other possible causes of CARP that have been suggested but seem less likely include endocrine abnormalities, Pityrosporum, a reaction to UV light, and a variation of cutaneous amyloidosis. CARP has been reported worldwide and occurs in both sexes, all age groups, and all races. The disorder can initially manifest as hyperkeratotic or verrucous papules that coalesce to form a reticular pattern peripherally and confluent plaques centrally. Although a variety of treatments for CARP exist, oral minocycline 50-100mg twice daily has been the preferred treatment. However, recent reports of the effectiveness of azithromycin 250-500mg three times weekly may make azithromycin the preferred treatment for CARP, since it has a more benign adverse effect profile than minocycline. Other effective antibacterial treatments include fusidic acid 1000mg daily, clarithromycin 500mg daily, erythromycin 1000mg daily, tetracycline 500mg twice daily, and cefdinir 300mg twice daily. If a recent finding that CARP is caused by a bacterial microorganism is replicated, treatment should likely be determined by bacterial sensitivities, antibacterial adverse effect profiles, and cost considerations. Other oral treatments of CARP that are effective but currently disfavored because of the effectiveness of minocycline include isotretinoin, acitretin, and etretinate. There have been mixed reports regarding the effectiveness of topical treatments, which include selenium sulfide, ketoconazole cream, tretinoin, tazarotene, tacalcitol, and calcipotriene (calcipotriol).
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              Keratosis lichenoides chronica: proposal of a concept.

              It has been a subject of controversy whether keratosis lichenoides chronica (KLC) is a distinctive inflammatory disease of the skin or whether it represents a manifestation of another well-known disease, such as lichen planus, lupus erythematosus, or lichen simplex chronicus. In search of clear criteria for diagnosis of KLC the entire literature pertinent to the subject was studied and findings clinical and histopathologic as they were telegraphed in them were compared with a patient of my own experience. Review of the literature reveals more than 60 patients in whom the diagnosis of KLC was made. Three categories emerge based on whether the findings presented in a particular article (1) do not permit any diagnosis to be rendered; (2) do allow a diagnosis specific to be made, such as of lichen simplex, lichen planus, or lupus erythematosus; or (3) do not correspond to any disease well defined, such as lichen simplex, lichen planus, lupus erythematosus, but seem to show attributes morphologic, clinically and histopathologically, that are repeatable. Patients diagnosed as having KLC obviously represent a potpourri of different diseases, the most common of them being lichen simplex chronicus, lichen planus, and lupus erythematosus. Fewer than 25 patients reported on, however, presented themselves with lesions very similar to one another clinically, namely, an eruption that involved the face in a manner reminiscent of seborrheic dermatitis and with tiny papules on the trunk and extremities, which assumed linear and reticulate shapes by way of confluence of lesions. Individual papules were infundibulocentric and acrosyringocentric. Findings histopathologic were those of a lichenoid interface dermatitis affiliated with numerous necrotic keratocytes and covered by parakeratosis housing neutrophils in staggered fashion. These patients seem to have an authentic and distinctive condition that is exceedingly rare. In conclusion, the diagnosis of KLC should be made only for patients who present themselves with features clinical and findings histopathologic that resemble closely those of what is summarized in this article under category 3.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                28 April 2022
                April 2022
                : 14
                : 4
                : e24557
                Affiliations
                [1 ] College of Medicine, Umm Al-Qura University, Makkah, SAU
                [2 ] Dermatology, King Abdulaziz Hospital, Makkah, SAU
                Author notes
                Article
                10.7759/cureus.24557
                9138193
                35651451
                c64c9f04-6640-4243-b9ef-5be9488660e6
                Copyright © 2022, Banjar et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 28 April 2022
                Categories
                Dermatology
                Pediatrics

                confluent and reticulated papillomatosis,dermatology case report,gougerot and carteaud,pediatric case,rare presentation,generalized lesions

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