Effective treatment of confluent and reticulated papillomatosis with oral doxycycline and an aqueous cream containing clindamycin, sulfur and salicylic aci

Abstract

Confluent and reticulated papillomatosis (CRP) is considered a rare inflammatory skin disease that presents with brown, velvety macules, papules and plaques in a net-like pattern, coalescing centrally with overlying scaling. Typical affected areas are the neck, back, chest and axilla. Diagnosis is sometimes challenging as CRP can be confused with other dermatoses, most commonly tinea versicolor. This also presents a therapeutic challenge as incorrect diagnosis may lead to inappropriate treatment. The bacteria Dietzia Papillomatosis, increased BMI, disordered keratinization and other factors have been associated with the condition. Recent literature indicate that CRP is not triggered by fungal infection. This case series highlights 3 patients with clinically diagnosed CRP, who were treated with a topical 3% clindamycin, 3% sulfur and 3% salicylic acid in aqueous cream mixture along with oral doxycycline 100mg daily for 6 weeks. At the 6 weeks follow up visit, patients demonstrated approximately 90-95% improvement in hyperpigmentation, papules, plaques and scaling. Recurrence occurred within 2 years for all 3 patients, but to a lesser extent than initial presentation and with similar response to repeated treatment.