Letter to the Editor
Confluent and reticulated papillomatosis manifested as vertically rippled and keratotic plaques

Confluent and reticulated papillomatosis (CRP) is a rare dermatosis of uncertain etiology that preferentially affects young adults. Eruptions usually present as grayish brown, flat elevated, keratotic papules and plaques that are confluent centrally and reticulated peripherally. It most commonly involves the intermammary and epigastric regions. We reported a young boy of CRP manifesting vertically rippled and keratotic streaks on his trunk.
An 18-year-old boy was admitted to our dermatology department with vertically rippled and keratotic eruptions on the trunk. Two years ago, the patient noticed light brown and rippled streaks on his epigastric area. It became abruptly spreading on the chest, the back and waist during recent 6 months. There were no itching or other complaints. His past medical history was noncontributory. At the time of our observation, his height and weight were 170 cm and 89 kg, respectively, with a body mass index equal to 30.8 kg/m² (normal value < 25 kg/m²). Cutaneous examination showed brownish-black, vertically rippled and keratotic streaks involving his abdomen and the waist. In addition, red papules and plaques were seen around the axilla and antecubital fossae (Figures 1 and 2). An unstained specimen and culture of fine scale obtained from skin scrapings was negative. No fluorescence was observed in the affected skin under a Wood light examination. The biopsy specimens taken from the epigastric region revealed slight basket-weave hyperkeratosis, squat papillomatosis and a slight perivascular mononuclear infiltration in the upper dermis (Figure 3). Amyloid deposition was not identified with Congo red stain. The results of the laboratory evaluation and chemistry profile were within normal limits, and no endocrine imbalance including diabetes mellitus was detected.
The diagnosis of CRP was finally made on the basis of supportive histology and characteristic clinical features except its rippled appearance. We initiated treatment with Calcipotriol cream twice daily for 2 months. There was no improvement, and treatment was switched to isotretinoin with an initial dose of 30 mg on alternate days. In the 3^rd month of follow-up, partial flattening and fading of the lesions was observed. Complete resolution was still not obtained at the time of the 5^th month and the patient was unwilling to accept any further treatment.
Confluent and reticulated papillomatosis is an uncommon...


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