Hair Casts and Cutaneous Spicules in Multiple Myeloma

December 2006 in “ Archives of dermatology ”

Jeffrey J. Miller, Bryan Anderson, Michael D. Ioffreda, Michael B. Bongiovanni, Anneli C. Fogelberg

hair casts cutaneous spicules hyperkeratosis parakeratosis monoclonal IgG protein eosinophilic material chemotherapy

TLDR Hair casts and cutaneous spicules can be signs of multiple myeloma.

The document described a case of a 70-year-old woman with multiple myeloma who exhibited cutaneous spicules on her nose and hair casts on her scalp and eyelashes. Biochemical analysis confirmed that these spicules and hair casts contained monoclonal IgG protein, the same as found in her serum. Histopathologic examination revealed hyperkeratosis and parakeratosis in the spicules and amorphous eosinophilic material in the hair casts. Despite various topical treatments, significant improvement was only observed after chemotherapy, which reduced her serum IgG levels. The study proposed that hair casts should be recognized as a characteristic finding in multiple myeloma, alongside cutaneous spicules.

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