To the Editor: Confluent and reticulated papillomatosis (CARP) presents with hyperpigmented macules and papules in a net-like distribution, usually confluent over the central chest, back, and neck, and reticulated as it spreads out centrifugally over the outer trunk and upper extremities. 1 McKenzie P.L. Ogwumike E. Agim N.G. Confluent and reticulated papillomatosis in pediatric patients at an urban tertiary care center. Pediatr Dermatol. 2022; 39: 574-577 Crossref PubMed Scopus (3) Google Scholar CARP may result from dysbiosis, endocrinologic imbalances, or keratinization disorders. Treatment often requires systemic agents and is complicated by high recurrence rates and concerns regarding the side effects of therapy. 2 Mufti A. Sachdeva M. Maliyar K. et al. Treatment outcomes in confluent and reticulated papillomatosis: A systematic review. J Am Acad Dermatol. 2021; 84: 825-829 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar