A point to make about punctate, pigmented, and verrucous papillomatosis
By Warren R. Heymann, MD
July 25, 2016
What is your mental image of the Gougerot-Carteaud (GC) syndrome? I equate it with confluent and reticulated papillomatosis, presenting on the trunk with hyperpigmented minimally raised plaques. The KOH examination is negative and there is a quick, characteristic response to antibiotics such as minocycline.
There have been reports of variants of GC, as described by Gougerot and Carteaud themselves in 1932: 1) punctate, pigmented verrucous papillomatosis; 2) confluent and reticulated papillomatosis; and 3) nummular and confluent papillomatosis (1). I had only been aware of the second variant.
Additionally, other forms of GC have been in the literature recently, such as the hypopigmented form (2).
I know I would have been fooled by the case presented by Ibekwe et al, a 23 year old Nigerian woman with multiple discrete dark, pigmented papules on the intermammary region, but also scattered papules on the malar region. I would have easily considered syringomata or sarcoidosis as a primary diagnosis; the histology of hyperkeratosis and papillomatosis was diagnostic of GC. The lesions resolved with 8 weeks of minocycline (3).
The punctate presentation of GC reminded me to make a point, notably related to the ongoing (and perpetual) controversy about eponyms. According to Armarani et al (4):
The debate over medical eponyms extends beyond the use of possessive vs nonpossessive forms into the use of eponymous terms in general. Proponents of medical eponyms argue that they provide convenient shorthand for both the profession and community alike, while embedding medical traditions and culture in our professional language. Opponents argue that medical eponyms do not reflect scientific discoveries, lack scientific accuracy, and are sometimes connected to inappropriate scientists and physicians (eg, Reiter’s syndrome refers to the Nazi physician and war criminal Hans Reiter). Most everyone agrees that the pervasiveness of eponyms would make their abolition nearly impossible.
While I understand that descriptive terms such as “confluent and reticulated papillomatosis” may conjure a mental image, it may actually hinder diagnostic thinking . When there are multiple clinical variants of a disorder, using an eponym as an “umbrella” term will allow greater mental flexibility, and potentially better diagnostic accuracy.
1. Palmoque FE, Hairston MA Jr. Confluent and reticulated papillomatosis of Gougerot and Carteaud. Arch Dermatol 1965; 92: 49-51.
2. Hudacek KD, et al. An unusual variant of confluent and reticulated papillomatosis masquerading as tinea versicolor. Arch Dermatol 2012: 148: 505-8.
3. Ibekwe PU, Ukonu BA. Punctate, pigmented, and verrucous papillomatosis: a rare variant of the Gougerot-Carteaud syndrome. Int J Dermatol 2016; 55: 806-8
4. Armarani A, et al: Finding the evidence with eponyms. JAMA Dermatol 2013; 149: 664-5.
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