Madarosis And Facial Keratinaceous Spines

A 66-year-old woman with a history of breast cancer and heart transplant developed a papular eruption with white keratinaceous spikes on her face and concurrent loss of eyebrows and eyelashes after transitioning to sirolimus. Histologic examination confirmed Trichodysplasia spinulosa (T. spinulosa) associated with T. spinulosa–associated polyomavirus (TSPyV). The recommended treatment involved reducing immunosuppression, which led to modest improvement, followed by the use of cidofovir 3% cream, resulting in further improvement. If untreated, T. spinulosa can lead to facial scarring and leonine facies.