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Follicular hyperkeratotic spicules
Other Resources UpToDate PubMed

Follicular hyperkeratotic spicules

Contributors: Katherine L. Boss Heckathorn MPH, Jeffrey Globerson DO, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Follicular hyperkeratotic spicules (FHS) is a rare disorder in which keratotic spicules arise from hair follicles on the nose, chin, forehead, or scalp. FHS lesions are asymptomatic or slightly pruritic. They can be easily removed without bleeding, but they will return within weeks.

Most cases of FHS are associated with an underlying multiple myeloma, but idiopathic cases have been rarely reported. FHS primarily affects patients aged 40-70 when associated with multiple myeloma and is seen in idiopathic cases primarily in patients older than 40.

The pathogenesis has not yet been fully elucidated. In many of the reported cases, the myeloma paraprotein is a cryoprotein, and cryoglobulinemia is a co-resenting clinical manifestation. It has been shown in some cases that paraprotein accumulates in the intercellular spaces of the infundibulum, giving rise to parakeratosis and follicular plugs that are composed of paraprotein and parakeratotic cells.

FHS has been reported to resolve with myeloma treatment and reappear with disease recurrence.

Codes

ICD10CM:
L73.9 – Follicular disorder, unspecified
L85.9 – Epidermal thickening, unspecified

SNOMEDCT:
81845009 – Follicular hyperkeratosis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Differential diagnosis of follicular spiny dermatoses:
Differential diagnosis of nonfollicular spiny dermatoses:
  • Multiple minute digitate hyperkeratosis – Nonfollicular, hyperkeratotic papules, predominantly found on the extremities and trunk.
  • Spiny keratoderma
  • Uremic frost

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:09/02/2021
Last Updated:10/27/2021
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Follicular hyperkeratotic spicules
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Follicular hyperkeratotic spicules
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