Cutaneous follicular hyperkeratotic spicules

Follicular spikes are a very rare but highly characteristic cutaneous manifestation, often occurring in the early stages of multiple myeloma (or other gammopathies) (Requena L et al. 1995). They have also been described in association with renal failure and Crohn's disease.

Hiniwes. The clinical picture was previously described under the name"trichodysplasia spinulosa".

The pathophysiology of this disease is unclear.

The spike-like hyperkeratoses typically appear as follicular pointed hyperkeratotic elevations in the follicular openings of the face, most commonly on or around the nose and forehead (Smith MP et al 2o19).

Spiny hyperkeratosis in gammopathy must be differentiated differentially from paraneoplastic acrokeratosis the Bazex syndrome, especially since this syndrome has also been described in association with multiple myeloma (Kandemir Alibakan Ö et al. 2020).

1. Braun RP et al (2002) Multiple hyperkeratotic spicules and myeloma. Dermatology. 205:210-212.
2. Kandemir Alibakan Ö et al (2020) An Unconventional Presentation of Multiple Myeloma: Bazex Syndrome. Turk J Haematol 37: 294-296.
3. Leerunyakul K et al (2019) A Case Report of Idiopathic Follicular Hyperkeratotic Spicules and Literature Review. Case Rep Dermatol 11:278-285.
4. Oymanns M et al (2021) Paraneoplastic Filiform Hyperkeratosis and Immunoglobulin-Associated Vasculitis in Myeloma Progression: A Case Report. Case Rep Dermatol 13:563-567.
5. Requena L et al (1995) Follicular spicules of the nose: a peculiar cutaneous manifestation of multiple myeloma with cryoglobulinemia. J Am Acad Dermatol 32: 834-839.
6. Smith MP et al (2o19) Follicular spicules of multiple myeloma. Dermatol Online J 25:13030/qt5bp8s5nn.
7. Tay LK et al (2010) Cutaneous follicular hyperkeratotic spicules--the first clinical sign of multiple myeloma progression or relapse. Int J Dermatol 49:934-936.