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Confluent and Reticulated Papillomatosis Workup

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

Laboratory Studies

KOH examination of skin scrapings in confluent and reticulated papillomatosis: Pityrosporum orbiculare or Pityrosporum ovale spores and rarely hyphae may be found.

Fungal culture in confluent and reticulated papillomatosis: P orbiculare or P ovale may be cultured in some cases. The laboratory needs to be informed to make specific modifications to the media to grow this yeast.

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Other Tests

Wood lamp examination in confluent and reticulated papillomatosis: Yellow fluorescence occurs when Pityrosporum organisms are present.

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Histologic Findings

In confluent and reticulated papillomatosis, the epidermis shows compact hyperkeratosis, often associated with the presence of Pityrosporum yeast. Other features are less consistent and include a decreased or absent granular cell layer, papillomatosis, and a stratum spinosum that varies from acanthotic to atrophic. Because papillomatosis is an inconsistent feature, one paper has proposed changing the name of confluent and reticulated papillomatosis to confluent and reticulated papulosquamous eruption. This name is also less than perfect because most patients have little-to-no scale associated with the lesions. The dermis may contain a perivascular lymphocytic infiltrate.

On electron microscopy, some lesions demonstrate an alteration in the arrangement and the structure of cornified cells, an increased transitional cell layer, an increase in the number of lamellar bodies in the stratum granulosum, and an increased number of melanosomes in the stratum corneum.[32]

Immunohistochemical analysis shows suprabasal keratin 16 expression with intense focal staining in the stratum granulosum and an increased number of epidermal cells with Ki-67 binding in the basal layer and stratum malpighii. See the image below.

A biopsy specimen showing hyperkeratosis, papillom A biopsy specimen showing hyperkeratosis, papillomatosis, and a mild superficial perivascular inflammation (hematoxylin and eosin, original magnification X125).
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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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