Confluent and reticulated papillomatosis (CARP) is a chronic dermatologic condition marked by hyperpigmented, verrucous papules and plaques that merge into a characteristic net-like, reticulated pattern, most frequently localized to the upper trunk, axillae, and shoulders. Although the pathogenesis of CARP remains poorly understood, abnormalities in keratinization and bacterial overgrowth, particularly Corynebacterium species, have been implicated. Historically, oral antibiotics, particularly minocycline, have been the mainstay of treatment due to their dual antimicrobial and anti-inflammatory properties. However, concerns over long-term antibiotic use—including risks of gastrointestinal disturbances, photosensitivity, cutaneous side effects, and the growing global issue of antibiotic resistance—have provoked interest in alternative or adjunctive therapies. This comprehensive review examines topical treatment modalities, such as topical minocycline, which minimizes systemic absorption while retaining local efficacy, as well as the use of retinoids like adapalene to regulate keratinization, and keratolytic agents, including salicylic acid and ammonium lactate, which enhance epidermal turnover. By evaluating clinical outcomes, safety profiles, and recurrence rates associated with these topical agents, this review aims to determine their viability as standalone therapies or as adjuncts to oral antibiotics, offering a more targeted, safer approach to managing CARP without the systemic risks tied to prolonged antibiotic use.
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