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CONFLUENT AND RETICULATED PAPILLOMATOSIS (GOUGEROT‐CARTEAUD) TREATED WITH TETRACYCLINES

A 29-year-old female student of Tunisian origin first consulted us In January 1993 for an eruption on the trunk that had started 6 years before as papules in the epigastric region. It gradually spread, was chronic in nature, and worse In the summer. Successive courses of topical antifungal agents were unsuccessful. There were no relevant features in her past medical or family histories. Clinically, the eruption was erythematopapular, pigmented, hyperkeratotic in places, formed a reticular pattern, and itched slightly. It reached the cervical, intermammary, epigastric, and medial dorsal regions and roughly formed an anterior and a posterior vertical diamond shape. There were also associated atrophic axillary lesions. No fluorescence was seen on Wood's light examination. Laboratory investigations, including full blood count, erythrocyte sedimentation rate, clotting screen, serum concentrations of sodium, potassium, chloride, transaminases, and alkaline phosphatase, renal function, a glucose cycle, a thyroid screen, and serum cortisol were all normal. Histologically, a skin biopsy specimen demonstrated parakeratotic hyperkeratosis with associated papillomatosis and a moderate perivascular mononuclear infiltrate. Staining with periodic acid-Schiff reagent (PAS) showed up yeasts in the stratum corneum, but Congo red staining did not show the presence of any amyloid deposits. Electron-microscopy did not reveal any abnormalities. A swab taken from the thoracic lesions and examined for fungi, showed a small quantity of Pityrosporum ovale spores. A diagnosis of confluent and reticulated papillomatosis (Gougerot-Cateaud) was made in view of the typical clinical appearance that fulfilled the authors' criteria, and the compatible, albeit nonspecific, histologic pattern. Treatment was commenced with doxycycline, 200 mg per day and was followed by a dramatic improvement after just 1 month and a total cure by 3 months. The patient has been followed up so far for 9 months without any recurrence.