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December 2006

Spiny Hyperkeratotic Projections on the Face and Extremities of a Kidney Transplant Recipient—Diagnosis

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Arch Dermatol. 2006;142(12):1643-1648. doi:10.1001/archderm.142.12.1644-d

Histopathologic examination of the skin biopsy specimens revealed distorted and enlarged follicular units with a widened inner root sheath, a hair matrix, and absent hair papillae. There was cornification with large eosinophilic trichohyaline granules and abortive hair shaft keratin formation. The outer root sheath was not conspicuous. Immunohistochemical studies, electron microscopy, and polymerase chain reaction evaluation failed to identify viral infection.

Initial treatment with daily 0.25% tretinoin cream was unsuccessful. The most cosmetically troubling lesions on the patient's face were treated surgically by shaving to the level of the surrounding skin. Subsequent treatment with 0.5% tazarotene gel has resulted in significant improvement.

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