Follicular spicules of multiple myeloma

Follicular spicules are a very rare but highly characteristic cutaneous manifestation of multiple myeloma. The spicules typically appear as hyperkeratotic horns in the follicular openings of the face, most commonly on or around the nose and forehead. The pathophysiology of this condition has not been fully elucidated and remains an active area of research and debate. Herein we describe a patient who presented with follicular spicules in the context of unintentional weight loss, anemia, and elevated inflammatory markers. We discuss the diagnostic work-up for such a presentation, review the classification of follicular spicules of multiple myeloma, and describe approaches to manage this uncommon skin condition.