SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD
A 9-year-old girl developed a mildly pruritic follicular eruption near the completion of chemotherapy (mercaptopurine, methotrexate, vincristine, and dexamethasone) for pre –B-cell acute lymphoblastic leukemia. When she first presented to the dermatology clinic, her leukemia was in remission and she was systemically well. Her only regular medication was a course of prophylactic trimethoprim-sulfamethoxazole, which was completed shortly thereafter.
Skin examination revealed an eruption of follicular crusted papules with keratotic spines on the patient's face, including prominent eyebrow involvement. Her shoulders, arms, and legs were also affected (Figure 1). Her eyebrow hair was thinned, but scalp alopecia was not present. Palmoplantar surfaces and nails were uninvolved. The results of her physical examination were otherwise unremarkable. A punch biopsy specimen was obtained from a papule (Figure 2 and Figure 3).
Burns A, Arnason T, Fraser R, Murray S, Walsh N. Keratotic “Spiny ” Papules in an Immunosuppressed Child —Quiz Case. Arch Dermatol. 2011;147(10):1215-1220. doi:10.1001/archdermatol.2011.286-a