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To the Editor Hyperkeratotic spicules may develop as a paraneoplastic syndrome of multiple myeloma. These follicular spicules in multiple myeloma (FSMM) are composed of precipitates of monoclonal dysproteins identical to the serum protein found in these patients.1 Light microscopy of the affected follicular epithelium shows intercellular deposits of eosinophilic material that has been identified as IgG by direct immunofluorescence.1 Trichodysplasia spinulosa (TS) is a distinct disorder that also presents with follicular spicules in the setting of immunosuppression.2 There is increasing evidence that the TS polyomavirus (TSPyV) is involved in the pathogenesis of TS.3
Hosler GA, Weibel L, Wang RC. The Cause of Follicular Spicules in Multiple Myeloma. JAMA Dermatol. 2015;151(4):457-458. doi:10.1001/jamadermatol.2014.4379