PMC9102115_01
Trichodysplasia spinulosa. Keratotic follicular white spicules.
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At the time of assessment, the patient's immunosuppression consisted of Prednisone 2.5 mg daily (tapering dose) and mycophenolate mofetil (MMF) 1 g twice daily (Figure 1).
(a) Low power photomicrograph (50x) of an H&E stained section of skin showing dilated follicular infundibulum with keratin plugging and abnormal maturation with marked inner root sheath differentiation (black arrow). Abnormal hair bulbs lacking fully formed papillae are noted. (b) Medium power photomicrograph (100x). The inner root sheath cells have prominent eosinophilic cytoplasm with numerous trichohyaline granules. Dyskeratotic cells are also seen (black triangle).
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These changes were consistent with the diagnosis of TS (Figure 2).