Trichodysplasia spinulosa is a rare viral infection seen in immunocompromised patients. It is caused by reactivation of trichodysplasia spinulosa-associated polyomavirus (TSPyV). Patients develop flesh-colored or erythematous follicular papules on the central face, alopecia, and facial disfigurement. Primary exposure to TSPyV occurs in early childhood, and most people (63%-80% of immunocompromised and immunocompetent populations) become seropositive by adulthood. Infected individuals do not develop clinical manifestations unless in the setting of immunosuppression. Follicular inner root sheath keratinocyte hyperproliferation secondary to molecular interactions between host anti-oncogenes and viral antigens are thought to produce the characteristic spiny-filiform papular lesions.
Risk factors for development of trichodysplasia spinulosa reflect immunosuppression: AIDS, iatrogenic immunosuppression (use of immunosuppressive medication), solid organ transplant, and malignancy.
This condition was previously known as viral-associated trichodysplasia, cyclosporine-induced folliculodystrophy, pilomatrix dysplasia, and trichodysplasia of immunosuppression.
ICD10CM: B34.9 – Viral infection, unspecified
SNOMEDCT: 723544007 – Trichodysplasia spinulosa caused by Polyomavirus
Differential Diagnosis & Pitfalls
Multiple minute digitate hyperkeratosis
Spiky follicular mycosis fungoides
Disseminated spiked hyperkeratosis
Follicular graft-versus-host disease
Frictional lichenoid eruption
Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.