Dermatoscopy Case of the Month: Trichodysplasia Spinulosa
November 2021
in “
JAAD case reports
”
trichodysplasia spinulosa TS-associated polyomavirus follicular hyperkeratotic papules perifollicular hyperpigmentation trichohyalin granules follicular keratinocyte apoptosis leonine facies topical cidofovir systemic valganciclovir TS polyomavirus hyperkeratotic papules hyperpigmentation keratinocyte apoptosis cidofovir valganciclovir
TLDR A man with a weakened immune system was diagnosed with a rare skin condition called trichodysplasia spinulosa using skin examination techniques.
A 52-year-old renal transplant patient presented with brown-to-pink papules and follicular hyperkeratotic papules, along with thinning eyebrows and eyelashes. Dermatoscopy showed perifollicular hyperpigmentation with central white circles and bright white spicules. Histopathology confirmed trichodysplasia spinulosa (TS), a rare condition in immunosuppressed patients caused by TS-associated polyomavirus. TS is characterized by dilated hair follicles with trichohyalin granules and follicular keratinocyte apoptosis. Timely diagnosis is crucial to prevent progression to leonine facies. Dermatoscopic evaluation, particularly the presence of bright white spicules, aids in diagnosis. Treatment options include reducing immunosuppression, topical cidofovir, or systemic valganciclovir.
