Trichodysplasia spinulosa associated with lupus

Area of Science:

• Dermatology
• Virology
• Pathology

Background:

• Trichodysplasia spinulosa (TS) is a rare skin condition typically seen in immunosuppressed individuals.
• A novel Polyomavirus, trichodysplasia spinulosa-associated Polyomavirus (TSV polyomavirus), has been identified in TS lesions, suggesting a viral etiology.
• Treatment with cidofovir has shown clinical improvement, further supporting the viral hypothesis.

Observation:

• A 26-year-old woman with lupus erythematosus, not previously transplanted or on immunosuppressants, presented with a progressive facial rash.
• The eruption consisted of confluent papules and spiky filiform excrescences primarily on the midface.
• Histopathology revealed abnormal hair follicle maturation and eosinophilic inclusions containing TSV polyomavirus DNA.

Findings:

• This case represents the first documented instance of TS in a lupus patient without a history of transplantation or underlying hematological disease.
• Polymerase chain reaction confirmed the presence of TSV polyomavirus DNA in the patient's skin lesions.
• The clinical presentation and histological findings were consistent with TS.

Implications:

• This case expands the known clinical spectrum of TS and its association with autoimmune diseases like lupus erythematosus.
• It highlights that TS can occur in non-immunosuppressed individuals, challenging previous assumptions about its pathogenesis.
• The findings underscore the importance of considering viral etiologies, specifically TSV polyomavirus, in the differential diagnosis of unusual facial dermatoses.