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CASE REPORT
Year : 2009  |  Volume : 54  |  Issue : 5  |  Page : 60-62
Two cases of confluent and reticulated papillomatosis successfully treated with Chinese drug jianpizhiyang granula


First Affiliated Hospital of Zhejiang Chinese Medical University, Youdian Road 45, Hangzhou City, Zhejiang Province, China

Correspondence Address:
Xiao-Hong Yang
Dermatology Department, the First Affiliated Hospital of Zhejiang Chinese Medical University, Youdian Road 45, Hangzhou City, Zhejiang Province
China
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Source of Support: None, Conflict of Interest: None


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   Abstract 

Confluent and reticulated papillomatosis (CRP) was first described in 1927 by Gougerot and Carteaud. It is characterized by papules that become confluent in the center and reticulated at the periphery. The etiology and pathogenesis of CRP are not precisely known and there is no standard therapy for it. In the recent cases reported, treatment of choice is minocycline. In this report, we present two cases of CRP responding well to Chinese drug, Jianpizhiyang. Some elements in Jianpizhiyang granula were thought to have anti-inflammatory. We expect that, which always has little side-effect, will be a good choice for CRP.


Keywords: Confluent and reticulated papillomatosis, Gougerot-Carteaud syndrome, Chinese drug


How to cite this article:
Yu TG, Cao Y, Yang XH, Deng D, Lan SH. Two cases of confluent and reticulated papillomatosis successfully treated with Chinese drug jianpizhiyang granula. Indian J Dermatol 2009;54, Suppl S1:60-2

How to cite this URL:
Yu TG, Cao Y, Yang XH, Deng D, Lan SH. Two cases of confluent and reticulated papillomatosis successfully treated with Chinese drug jianpizhiyang granula. Indian J Dermatol [serial online] 2009 [cited 2019 Oct 22];54, Suppl S1:60-2. Available from: http://www.e-ijd.org/text.asp?2009/54/5/60/45459



   Introduction Top


 Gougerot-Carteaud syndrome More Details or confluent and reticulated papillomatosis (CRP), was first described by Gougerot and Carteaud as dermatosis in 1927. [1] CRP is an uncommon dermatosis that affects young individuals and teruption consists confluent, flat, red-brownish papules localized primarily to the intermammary and interscapular regions with subsequent spread to the breast and arms; at the periphery, the papules spread out forming a pigmented reticulated pattern. Disease begins on an average, in the late teens or early twenties, has an approximately equal sex distribution, and affects whites, blacks, and Asian patients. [2]

The etiology and pathogenesis of CRP are not precisely known. The two prominent theories are an abnormal host response to fungi [3] and a keratinization defect. [4] Other hypothesis include photosensitivity, [5] genetic factor [6],[7] and endocrinopathy. [4] Confluent and reticulated papillomatosis is generally resistant to therapy. Responses to retinoid ointments, [8] antifungal agents [3],[6] and various oral antibiotics [9],[10] have been described, the treatment of choice is minocycline 100mg twice daily for six weeks. [11],[12],[13] But application of minocycline is limited in patients with hepatic or renal inadequacy. Since the adverse effect of it is mentioned in this report, we present two cases of CRP responding well to Chinese drug-Jianpizhiyang, which always has a little side-effect.


   Case History Top


Patient 1

A 20-year-old girl was admitted to our dermatology department with red-brown eruptions on her back, arms with a history of about 1.5-month. She denied a family history of similar lesions and there were no other complaints. On examination, she had scaly, red-brown, velvety on her back, upper-arms and the intermammary regions, and the papules were confluent in the center and reticulated at the periphery [Figure 1]. Physical examination showed that the patient was 155cm tall, weighed 60.5kg, and had a body mass index of 25.2%; she was a little obese. Histopathological examination of skin biopsy specimens from the back were performed and showed obvious hyperkeratosis, granular layer, pachyntic prickle cell layer and slight papillomatosis of the epidermis [Figure 2]. The superficial dermis there was a perivascular discrete lymphocytic infiltration. Scales were sampled from the intermammary regions of chest, but microscopy found no evidence of Malassezia furfur or other fungi. Blood test showed no abnormalities in fasting blood glucose (91mg/dL). On the basis of the clinical and histopathological findings, a diagnosis of confluent and reticulated papillomatosis (CRP) was made.

Patient 2

A 22-year-old Chinese man had a two-month history of reticular pigmented rashes on the chest and arms. There were no other complaints and no similar family history. On examination, he had red-brown reticular with relatively clear borders on the chest and upper-arms. Scales were also present in some areas [Figure 3]. Physical examination showed that the patient was not obese, had a body mass index of 20.7%. Histopathological examination of skin biopsy specimens from the left upper arm were performed in another hospital and showed papillomatosis of the epidermis and slight hyperkeratosis (data not shown). The basal layer showed a slight increase of melanin in some areas. Light perivascular chronic inflammatory infiltrations were observed in the dermis, while no changes were observed in the subcutaneous fatty tissue. Scrapings were taken for microbiological examination. On microscopy, no fungal elements were seen. On the basis of the clinical and histopathological findings, the patient was diagnosed as CRP.

Therapy and outcome confluent and reticulated papillomatosis is generally resistant to therapy. In this report, Glucocorticoid ointment and antihistamin agent had been applied in the treatment of the two patients in other hospitals for several weeks, without any improvement in the skin rashes. When they came to our department, we treated the two persons with BID. Jianpizhiyang mainly includes diffusa, dictamni cortex, licorice root and atractylodes macrocephala. Within one week, the patients turn out exciting results, with the red-brownish papules turned into flat brownish and some papules fade away [Figure 1],[Figure 3].


   Discussion Top


CRP is a rare skin condition; its etiology and pathogenesis are still poorly understood. The majority of CRP cases were sporadic, although familial occurrences had been reported. [7],[14] In 1969, Roberts and Lachapelle suggested that CRP are probably caused by Pityrosporum orbiculare, and recently, cases had been reported that sometimes CRP respond well to agents. [3],[6] But in this report, both the cases denied the familial history of the similar occurrences and there were no furfur or other fungi found in the scales. The etiology of CRP is waiting for the review of more CRP cases.

There is no standard therapy for CRP etiology of it remains unclear. Various treatments have been tried, and there have been some reports of CRP responding to antibiotics, especially in recent years. [11],[12],[13] And minocycline has become the drug of choice for this idiopathic condition. The anti-inflammatory effects of minocycline have been attributed to their ability to inhibit the migration of neutrophils, prevent release of reactive oxygen species, and inhibit matrix metalloproteinases. [15] The response of CRP to these specific antibiotics may be related more to their anti-inflammatory properties than to antimicrobial effects. [6]

In this report, both patients responded well to the Jianpizhiyang granula, which mainly including diffusa, dictamni cortex, licorice root and atractylodes macrocephala. This report for the first time presents the successful therapy of CRP with Chinese Drug. They were prepared by the first hospital of Chinese Medical University and had good effect in the therapy of atopic dermatitis. Diffusa and dictamni cortex were thought to have anti-inflammatory properties in traditional medicine. To minocyline, Jianpizhiyang has low reaction and it reduces the anti-inflammatory properties by modulating the whole immunity.

 
   References Top

1.Gougerot H, Carteaud A. Papillomatose pigmentee innominee. Bull Soc Fr Dermatol Syphiligr 1927;34:719-21.  Back to cited text no. 1    
2.Lee MP, Stiller MJ, McClain SA, Shupack JL, Cohen DE. Confluent and reticulated papillomatosis: Response to oral isotretinoin therapy and reassessment of epidemiologic data. Am Acad Dermatol 1994;31:327-31.  Back to cited text no. 2    
3.Hamaguchi T, Nagase M, Higuchi R, Takiuchi I. A case of confluent and reticulated papillomatosis responsive to ketoconazole cream. Nippon Ishinkin Gakkai Zasshi 2002;43:95-8.  Back to cited text no. 3  [PUBMED]  
4.Carrozzo AM, Gatti S, Ferranti G, Primavera G, Vidolin AP, Nini G. Calcipotriol treatment of confluent and reticulated papillomatosis (Gougerot-Carteaud syndrome). J Eur Acad Dermatol Venereol 2000;14:131-3.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Vassileva S, Pramatarov K, Popova L. Ultraviolet light-induced confluent and reticulated papillomatosis. Am Acad Dermatol 1989;21:413-4.  Back to cited text no. 5    
6.Stein JA, Shin HT, Chang MW. Confluent and reticulated papillomatosis associated with tinea versicolor in three siblings. Pediatr Dermatol 2005;22:331-3.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Inaloz HS, Patel GK, Knight AG. Familial confluent and reticulated papillomatosis. Arch Dermatol 2002;138:276-7.  Back to cited text no. 7    
8.Schwartzberg JB, Schwartzberg HA. Response of confluent and reticulate papillomatosis of Gougerot and Carteaud to topical tretinoin. Cutis 2000;66:291-3.  Back to cited text no. 8  [PUBMED]  
9.Davis RF, Harman KE. Confluent and reticulated papillomatosis successfully treated with amoxicillin. J Dermatol 2007;156:583-4.  Back to cited text no. 9    
10.Ito S, Hatamochi A, Yamazaki S. A case of confluent and reticulated papillomatosis that successfully responded to roxithromycin. J Dermatol 2006;33:71-2.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]
11.Chang SN, Kim SC, Lee SH, Lee WS. Minocycline treatment for confluent and reticulated papillomatosis. Cutis 1996;57:454-7.  Back to cited text no. 11  [PUBMED]  
12.Yamamoto Y, Kadota M, Nishimura Y. A case of maxacalcitol-resistant confluent and reticulated papillomatosis successfully treated with minocycline. J Dermatol 2006;33:223-4.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Davis MD, Weenig RH, Camilleri MJ. Confluent and reticulate papillomatosis (Gougerot-Carteaud syndrome): A minocycline-responsive dermatosis without evidence for yeast in pathogenesis: A study of 39 patients and a proposal of diagnostic criteria. Br J Dermatol 2006;154:287-93.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]
14.Henning JP, de Wit RF. Familial occurrence of confluent and reticulated papillomatosis. Arch Dermatol 1981;117:809-10.  Back to cited text no. 14  [PUBMED]  
15.Humbert P, Treffel P, Chapuis JF, Buchet S, Derancourt C, Agache P. The tetracyclines in dermatology. J Am Acad Dermatol 1991;25:691-7.  Back to cited text no. 15  [PUBMED]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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    Abstract
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    Case History
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