A 48-year-old woman presented with a 6-month history of pink papules with central spiny projections scattered over her face, arms, and legs. Her medical history was significant for kidney transplantation, which she had undergone because of lupus-related nephropathy and renal failure 9 years earlier. At the onset of her skin lesions, her immunosuppression therapy consisted of tacrolimus and mycophenylate mofetil. She denied having taken cyclosporine.
Physical examination revealed numerous 2- to 4-mm discrete, asymptomatic, erythematous, pink papules with central spiny projections (Figure 1 and Figure 2) distributed over the nose, malar eminences, upper cutaneous lip, arms and thighs. A punch biopsy specimen was obtained from the right cheek (Figure 3).
Campbell RM, Ney A, Gohh R, Robinson-Bostom L. Spiny Hyperkeratotic Projections on the Face and Extremities of a Kidney Transplant Recipient—Quiz Case. Arch Dermatol. 2006;142(12):1643-1648. doi:10.1001/archderm.142.12.1643-d