Follicular hyperkeratosis as a manifestation of Sézary syndrome

Multiple minute digitate hyperkeratosis: A proposed algorithm for the digitate keratoses

“…Treatment success has been reported with oral valganciclovir. 48 We favor ''trichodysplasia spinulosa'' over the synonymous terms presented in Table I, as it appears to be a viral infection that occurs in immunosuppressed individuals, not one or the other, and it is not specific to cyclosporine. The use of many synonymous terms and the previously proposed classifications 11,14,17,28 for the digitate keratoses can cause confusion.…”

“…It is distinct from 46 Trichodysplasia of immunosuppression 48 Viral-associated trichodysplasia spinulosa Pilomatrix dysplasia Cyclosporine-induced folliculodystrophy Spiny keratoderma 26,29,31,32 Punctate porokeratotic keratoderma 22,23,25,28 Music box spine dermatosis Multiple minute palmar-plantar digitate hyperkeratosis 24 Filiform hyperkeratosis 27,30 MMDH, Multiple minute digitate hyperkeratosis.…”

“…43 More recently two cases were reported associated with Sézary syndrome. 48 Histopathology reveals focal columns of orthokeratotic or parakeratotic hyperkeratosis with homogenous compact eosinophilic inclusions (immunoglobulin). Skin immunofluorescence may reveal intercellular epidermal immunoglobulin deposition, and if so identical serum monoclonal gammopathy is present.…”

A Case Report of Idiopathic Follicular Hyperkeratotic Spicules and Literature Review

“…Differential diagnosis of follicular hyperkeratotic spicules includes lichen spinulosus, multiple minute digitate hyperkeratosis, trichodysplasia spinulosa, and spiky follicular mycosis fungoides [4, 24, 25, 26, 27]. Details of these diseases regarding clinical manifestations, histopathological findings, and their associated conditions are summarized in Table 3.…”

Spiky follicular mycosis fungoides: a clinicopathologic study of 8 cases

“…The presence of hyperkeratotic follicular lesions has occasionally been observed during the course of FMF, but has usually been pooled with more typical lesions of the disease and there has been no detailed description of the histopathologic, immunophenotypical and/or molecular genotypic findings of these lesions . Recently, Al‐Niaimi et al have described two patients with Sezary syndrome who developed innumerable follicular hyperkeratotic spicules on the head and scalp. The histopathologic changes were suggestive of epidermotropic CTCL, even if there was no confirmation by immunohistochemistry and/or T‐cell rearrangement analysis.…”