A 5-year-old boy, known to have acute lymphoblastic leukemia since the age of 3 years, presented with a 3-week history of asymptomatic skin lesions primarily affecting the face and to a lesser extent the trunk and extremities (Figure, A and B). He had been undergoing a maintenance chemotherapy regimen consisting of vincristine sulfate, 6-mercaptopurine, methotrexate, and high-dose prednisone. He did not undergo bone marrow or stem cell transplant as part of his treatment. Multiple topical medications including keratolytics were applied to the affected areas without effect.
Ghosn S, Abboud M, Kurban M, Abbas O. Spiny Follicular Hyperkeratotic Papules on the Face. JAMA Pediatr. 2013;167(9):867-868. doi:10.1001/jamapediatrics.2013.2246