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Confluent and Reticulated Papillomatosis Medication

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
 
Updated: Jun 06, 2016
 

Medication Summary

The goals of pharmacotherapy in confluent and reticulated papillomatosis are to reduce morbidity and to prevent complications. Numerous agents are used.[57] The effects of the often-used antibiotics include their various anti-inflammatory or immunomodulating properties. Successful treatment with oral minocycline has been described.[30, 58] Erythromycin-resistant confluent and reticulated papillomatosis may respond to minocycline.[18] Low-dose isotretinoin may be beneficial in some patients with confluent and reticulated papillomatosis.[59, 11] Oral 13-cis-retinoic acid cleared one patient after a 20-week course.[60] Topical tacrolimus is another option.[61]  Selenium sulfide,[62] etretinate,[63, 64] and tacalcitol[65]  have been used successfully.

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Antifungals, Other

Class Summary

These agents are directed against Pityrosporum infection. Selenium also has keratolytic properties.

Clotrimazole topical (Lotrimin, Anti-Fungal, Cruex)

 

Clotrimazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing death of fungal cells. Reevaluate the diagnosis if no clinical improvement is observed after 4 weeks. Use 1% solution.

Miconazole topical (Lotrimin AF, Fungoid, Micaderm, DermaFungal)

 

Miconazole damages the fungal cell wall membrane by inhibiting biosynthesis of ergosterol. Membrane permeability is increased, causing nutrients to leak out and resulting in fungal cell death. Lotion is preferred in intertriginous areas. If cream is used, apply sparingly to avoid maceration effects. Use 2% cream.

Ketoconazole (Nizoral, Extina, Xolegel)

 

Ketoconazole is an imidazole broad-spectrum antifungal agent; it inhibits synthesis of ergosterol, causing cellular components to leak and resulting in fungal cell death.

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Retinoid-like Agents

Class Summary

These agents correct disorders of keratinization.

Tretinoin topical (Retin-A, Avita, Atralin, Tretin X)

 

Tretinoin inhibits microcomedo formation and eliminates existing lesions. It makes keratinocytes in sebaceous follicles less adherent and easier to remove. Tretinoin is available as 0.025%, 0.05%, and 0.1% creams. It is also available as 0.01% and 0.025% gels.

Isotretinoin (Amnesteem, Claravis, Myorisan, Sotret)

 

Isotretinoin is an oral agent that treats serious dermatologic conditions. Isotretinoin is the synthetic 13-cis isomer of the naturally occurring tretinoin (trans- retinoic acid). Both agents are structurally related to vitamin A. Isotretinoin decreases sebaceous gland size and sebum production. It may inhibit sebaceous gland differentiation and abnormal keratinization.

A US Food and Drug Administration–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin. For more information on this registry, see iPLEDGE. This registry aims to further decrease the risk of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.

Tazarotene (Tazorac, Avage)

 

Tazarotene is a retinoid prodrug whose active metabolite modulates differentiation and proliferation of epithelial tissue; it may also have anti-inflammatory and immunomodulatory properties.

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Antibiotics, Other

Class Summary

These agents are antibacterials, and they may have anti-inflammatory or antiproliferative effects.

Doxycycline (Adoxa, Alodox, Doxy 100, Bio-Tab, Doryx)

 

Doxycycline inhibits protein synthesis and, thus, bacterial growth, by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Minocycline (Dynacin, Minocin, Solodyn)

 

Minocycline treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma organisms.

Azithromycin (Zithromax, Zmax)

 

Azithromycin is used to treat uncomplicated skin and skin structure infections. It acts by binding to the 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Erythromycin (E.E.S., Ery-Tab, EryPed)

 

Erythromycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Clarithromycin (Biaxin, Biaxin XL)

 

Clarithromycin is a semisynthetic macrolide antibiotic that reversibly binds to P site of the 50S ribosomal subunit of susceptible organisms and may inhibit RNA-dependent protein synthesis by stimulating dissociation of peptidyl t-RNA from ribosomes, causing bacterial growth inhibition.

Cefdinir

 

Cefdinir is a third-generation cephalosporin indicated for uncomplicated skin infections.

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Topical Skin Products

Class Summary

Agents that inhibit enzymes involved in growth of epithelial tissue may be used. These agents correct disorders of keratinization.

Calcipotriene (Dovonex, Sorilux, Calcitrene)

 

Calcipotriene is a synthetic vitamin D-3 analog that regulates skin cell production and development. Use 0.005% cream, ointment, or solution.

Selenium sulfide topical (Tersi, Dandrex, Head & Shoulders, Selsun Blue)

 

Selenium has keratolytic properties[58] . Blocks enzymes involved in growth of epithelial tissue.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Ponciano D Cruz, Jr, MD Professor and Vice-Chair, Paul R Bergstresser Chair, Department of Dermatology, University of Texas Southwestern Medical Center

Ponciano D Cruz, Jr, MD is a member of the following medical societies: Texas Medical Association

Disclosure: Received consulting fee from RCTS for independent contractor; Received honoraria from Mary Kay Cosmetics for consulting; Received grant/research funds from Galderma for principal investigator.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Kenneth A. Becker, MD, to the development and writing of this article.

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Grayish brown hyperkeratotic papules and plaques in a confluent pattern on the intermammary region with a reticular pattern peripherally.
Close-up view of the interscapular area, again demonstrating a confluent pattern centrally and a more reticular pattern peripherally.
A biopsy specimen showing hyperkeratosis, papillomatosis, and a mild superficial perivascular inflammation (hematoxylin and eosin, original magnification X125).
 
 
 
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