A Diagnostic Enigma Unveiled in Asymptomatic Papulosquamous Lesions: Response to Retinoid Therapy

Abstract

Confluent and reticulated papillomatosis (CRP), or Gougerot-Carteaud syndrome, is a rare keratinization disorder characterized by persistent, asymptomatic, hyperpigmented, scaly lesions with a reticulated pattern and may be mistaken for other pigmentary and papulosquamous disorders. A 37-year-old woman presented with an 8 – year history of progressive, asymptomatic pigmentation over the trunk. Examination revealed multiple confluent, scaly, dark-brown patches and plaques with reticulation over the upper back, chest, and lateral trunk. Previous treatment with topical steroids, antifungals, and oral antibiotics had failed. KOH examination was negative, while histopathology showed hyperkeratosis, acanthosis, follicular plugging, basal hyperpigmentation, and mild superficial perivascular lymphocytic infiltrates, aiding the diagnosis of CRP. Treatment with oral acitretin 10 mg daily resulted in complete resolution within one month; the dose was then gradually tapered to twice weekly and subsequently once weekly over the next 6 months, and the patient remains under follow-up without recurrence. This case emphasizes the diagnostic difficulty of CRP and the potential role of low-dose oral acitretin as an effective treatment option. Keywords: Confluent and reticulated papillomatosis; Gougerot-Carteaud syndrome; Acitretin