Spiny Hyperkeratotic Projections on the Face and Extremities of a Kidney Transplant Recipient—Quiz Case

Campbell, Ross M.; Ney, Amy; Gohh, Reginald; Robinson‐Bostom, Leslie

doi:10.1001/archderm.142.12.1643-d

Cited by 23 publications

(39 citation statements)

References 2 publications

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“…In previously published reports, different names have been used to describe TS, such as trichodysplasia or pilomatrix dysplasia of immunosuppression, 19,27,29 cyclosporineinduced folliculodystrophy 30 or viral/virus-associated trichodysplasia. 13,15,[23][24][25][26]31 However, despite terminology differences, all cases represented immunocompromised patients that had follicular papules and spiny lesions on the face histologically characterized by enlarged, dysmorphic hair follicles consisting of IRS cells packed with trichohyalin.…”

Section: Discussionmentioning

confidence: 99%

Trichodysplasia spinulosa is characterized by active polyomavirus infection

Kazem

Meijden

Kooijman

et al. 2012

Journal of Clinical Virology

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Section: Discussionmentioning

confidence: 99%

Trichodysplasia spinulosa is characterized by active polyomavirus infection

Kazem

Meijden

Kooijman

et al. 2012

Journal of Clinical Virology

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“…IVIg has been tried in TOI with negative results 9. Another strategy is reduction of immunosuppression,18 and indeed, there are reports of TOI in patients on cyclosporine improving or resolving with cessation of cyclosporine therapy;5,7,8 Tazarotene 0.5% gel proved effective for TOI in one renal transplant patient on tacrolimus and mycophenolic acid, however, topical tretinoin was not helpful in several other case reports 3,8,19. Interestingly, innate immune response to polyoma viruses appears to be linked to activation of Toll-like receptors 2 and 420 which may explain why tretinoin, a TLR-2 downregulator,21 was not useful.…”

Section: Discussionmentioning

confidence: 99%

Trichodysplasia of immunosuppression treated with oral valganciclovir

Holzer

Hughey

2009

Journal of the American Academy of Dermatology

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Trichodysplasia of immunosuppression (TOI) is a newly described rare clinicopathologic entity usually found in transplant patients on chronic immunosuppressive medications or with hematologic malignancies. TOI consists of a cutaneous eruption of spiny papules predominantly affecting the face and arms. The distinct histopathologic picture includes abnormally maturing anagen follicles with hyperkeratotic infundibula and excessive inner root sheath differentiation. Given that intranuclear viral particles have been noted on electron microscopy of skin biopsy in several patients, a viral etiology is suspected. These viral particles are similar in shape and size to a polyoma virus, however, the virus has not been identified to date. There are reports of improvement of TOI with topical cidofovir or tazarotene 0.5% gel, but to our knowledge there has not been a report of near-complete resolution with oral valganciclovir. We report a case of TOI in a heart transplant patient on a chronic immunosuppressive regimen of sirolimus, mycophenolic acid and prednisone that demonstrated almost complete response to treatment with systemic valganciclovir.

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“…Multiple myeloma may be accompanied by follicular or nonfollicular keratotic spicules, which can be generalized or predominant on the face and scalp [29, 40]. Keratosis-pilaris-spinulosa-like lesions have been reported in paraneoplastic syndromes [47]. Finally, the recently recognized trichodysplasia of immunosuppression presents with follicular spiny projections [48].…”

Section: Discussionmentioning

confidence: 99%

Unilateral Spiny Hyperkeratosis

et al. 2008

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We describe the first case of unilateral spiny hyperkeratosis (SH) of the left hand, review the literature and discuss possible patho- mechanisms. SH can be sporadic or familial, often appearing in healthy individuals. However, there is an association with various malignancies in a significant number of the sporadic cases. Although there is no satisfactory explanation of this association, we agree with previous authors that a patient with SH appearing in adult life should be evaluated and followed for the presence of malignancy. Other patients with SH may suffer from a variety of nonmalignant diseases, which may be coincidental or causally related. SH is not a premalignant lesion of the skin and should not be confused with porokeratosis which has a malignant potential. Except for excision of individual lesions, there is no permanent cure.

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Spiny Hyperkeratotic Projections on the Face and Extremities of a Kidney Transplant Recipient—Quiz Case

Cited by 23 publications

References 2 publications

Trichodysplasia spinulosa is characterized by active polyomavirus infection

Trichodysplasia spinulosa is characterized by active polyomavirus infection

Trichodysplasia of immunosuppression treated with oral valganciclovir

Unilateral Spiny Hyperkeratosis

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