A woman in her 70s presented with a 1-year history of a facial cutaneous eruption initially affecting malar cheeks and eyebrows. Subsequently, it spread to involve the nose, chin, upper trunk, and extremities. The lesions were mildly pruritic. Medical history : A cadaveric renal transplant two years ago for end-stage renal failure. Medications : Mycophenolate mofetil 200 mg twice daily and tacrolimus 8 mg twice daily.
Tacrolimus levels were therapeutic. Physical examination revealed multiple 1mm flesh colored follicular papules and keratin spines against a diffuse erythematous background affecting the face (Image 1, 2) and upper trunk. Her scalp and eyebrow hairs were unremarkable. Serology results were unremarkable. Results of the skin biopsy from the right ear demonstrated dilatation and keratotic plugging of the hair infundibula with marked dystrophy and expansion of the inner root…
