Monday, February 01, 2016

Confluent and Reticulated Papillomatosis

The patient is a 21 yo man with a six month history of subtle scaly patches on both axillae.  He was treated by is internist with ketoconazole cream without effect.  A KOH prep was done and was negative.

Clinical Image:

Patches are slightly yellowish and there are islands of sparing.

Pathology: Hyperkeratosis, papillomatosis (increased compared to specimen B), mild epidermal hyperplasia and a superficial perivascular lymphocytic infiltrate consistent with confluent and reticulated papillomatosis.
NOTE: The differential diagnosis could include acanthosis nigricans. PAS stain is negative for fungal organisms.
Photomicrographs courtesy of Jonathan Ho MD MS, Department of Dermatopathology, Boston University School of Medicine

Diagnosis: confluent and reticulated papillomatosis.

This is a difficult diagnosis clinically and histologically.  It's  a type of "dermatological non-disease."  Without the help of an experienced dermatopathologist I doubt that this diagnosis would have been arrived at.

The patient will be treated with minocycline, 100 mg bid for a month.  If this is CARP the process will be resolved.

No comments:

Post a Comment

We welcome your comments. We endeavor to serve your patients and you. If you want us to respond, please add your name and email address. Some people have trouble uploading comments. In that case, please send comments directly to Thank you.