A Case Series of Hypopigmented Confluent and Reticulated Papillomatosis

Confluent and reticulated papillomatosis (CARP) is a rare keratinization disorder typically presenting as hyperpigmented, scaly papules that coalesce into reticulated plaques on the trunk of adolescents and young adults. Hypopigmented variants have only rarely been reported and are frequently misdiagnosed as tinea versicolor, resulting in delayed diagnosis and unnecessary antifungal therapy. We describe 2 young adults with biopsy-confirmed hypopigmented CARP who initially received multiple courses of oral and topical antifungal agents with minimal to no benefit. Both patients demonstrated widespread hypopigmented, scaly, coalescing plaques. Following histopathologic confirmation, antifungal treatments were discontinued, and oral minocycline was initiated, leading to clinical improvement. These cases add to the limited literature describing hypopigmented CARP and underscore that the disease's defining features are distribution and morphology rather than pigmentation. Recognition of this rarely reported variant is essential for timely diagnosis and initiation of appropriate treatment.