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Trichodysplasia spinulosa
Other Resources UpToDate PubMed

Trichodysplasia spinulosa

Contributors: Lorena A. Mija, Youssef M. Salem, Vivian Wong MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


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.


B34.9 – Viral infection, unspecified

723544007 – Trichodysplasia spinulosa caused by Polyomavirus

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Multiple minute digitate hyperkeratosis
  • Lichen spinulosus
  • Spiny keratoderma
  • Common wart
  • Trichoadenoma
  • Pilar sheath acanthoma
  • Acne vulgaris
  • Trichostasis spinulosa
  • Follicular hyperkeratotic spicules
  • Spiky follicular mycosis fungoides
  • Disseminated spiked hyperkeratosis
  • Follicular graft-versus-host disease
  • Lichen planopilaris
  • Vitamin A deficiency
  • Frictional lichenoid eruption
  • Alopecia mucinosa
  • Scleromyxedema
  • Keratosis pilaris
  • Follicular eczema
  • Lichen planopilaris
  • Lichen nitidus
  • Darier disease
  • Follicular ichthyosis
  • Milia

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      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.

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      Last Reviewed:11/20/2022
      Last Updated:12/15/2022
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      Trichodysplasia spinulosa
      A medical illustration showing key findings of Trichodysplasia spinulosa : Sparse eyebrows, Eyelash madarosis
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