SPINY HYPERKERATOSES IN A RENAL-TRANSPLAN T RECIPIENT - A NOVEL SIDE-EFFECT OF CYCLOSPORINE-A

We report a 31-year-old renal transplant patient treated with cyclospo rin A who developed an unusual sebaceous gland hyperplasia accompanied by a disseminated follicular spiny hyperkeratosis. Those alterations were most evident on his face and limbs. In some locations hairy hyper keratosis with authentic hair neogenesis was found. The histology of t hese alterations showed a marked hyperkeratosis of the hair follicles with formation of hair-like spikes either alone or in connection with hairs. The presence of true hairs distinguishes our case from the morp hologically similar disseminated spiked hyperkeratosis and other spiny keratinization disorders. Scanning electron microscopy helped to demo nstrate the hair-like structure of these keratoses. Some of the sebace ous glands showed cystic widening of their lumina, which were filled w ith abundant amorphous eosinophilic material, a finding similar to ear lier observations. Our case demonstrates that these skin alterations s hould be classified as side effects of cyclosporin A and that they are apparently dose-dependent.