Abstract

Trichodysplasia spinulosa (TS) is a rare condition caused by the trichodysplasia spinulosa-associated polyomavirus (TSPyV). In this case report, we describe a 57-year-old female kidney transplant recipient who presented with multiple pruritic, 1-2 mm skin-colored papules on her central face. The lesions had been present for several months, and the patient had no prior history of acne. She had seen two dermatologists and tried exfoliants, extractions, and a course of minocycline and retinoid cream with no improvement. The patient presented to our clinic for a cosmetic consultation, and the initial clinical impression was of adult-onset acne. A 3 mm punch biopsy was performed. Histological examination showed dilated hair follicles and keratinocytes with prominent trichohyalin inclusions, findings characteristic of TS. The patient was treated with valacyclovir and a reduction of her immunosuppressive medications. She showed clinical improvement after two months of treatment. There are approximately 50 reported cases of TS, which commonly occurs in organ transplant recipients and in patients who receive immunosuppressive medications. As in our case, TS is often initially misdiagnosed, causing a delay in treatment. Early and accurate diagnosis of TS is critical as, left untreated, it can cause disfigurement. Trichodysplasia spinulosa polyomavirus should be considered in solid organ transplant recipients and other immunocompromised patients who present with a new onset of follicular papules on the central face.

Financial Disclosure:
No current or relevant financial relationships exist.