Confluent and reticulated papillomatosis : response to isotretinoin

Case report. A 20-year-old black man had hyperpigrnented, slightly raised plaques on his face, chest, and back for several months. He was otherwise in good health, and his only medication was a vitamin supplement. The patient's condition had been diagnosed as tinea versicolor, but the results of several tests with KOH preparations were negative, and the condition had not responded to several months of topical 2.5% selenium sulfide lotion or 1 week of ketoconazole, 200 mg/day. Microscopic examination of a biopsy specimen from his chest revealed hyperkeratosis and papillomatosis similar to that of acanthosis nigricans. The clinical and histopathologic findings were consistent with CRP. The results of the laboratory evaluation, including CBC, chemistry profile, and serologic test for syphilis, were within normal limits. The patient was treated with tretinoin cream (Retin-A), 0.1% daily for 2 months, then tretinoin 0.025% gel twice daily, and hydroquinone 4% cream for I month, without improvement. Isotretinoin, 40 mg/day, was then started. After 1 month there was no change, but after 2 months of therapy the eruptions cleared completely and the isotretinoin was discontinued. The only side effect was cheilitis. The patient's skin has remained clear for 4 months except for a recurrence of slightly hyperpigmented macules on his neck.