Pilomatrix dysplasia in an immunosuppressed patient

Immunosuppressive drugs have been used for many years in the prevention of graft failure in transplant recipients. Although they improve morbidity and mortality after transplantation, these medications carry a significant ris k of adverse mucocutaneous and systemic effects. We describe a patient rece iving 4 immunosuppressive drugs who experienced persistent facial dysmorphi sm along with striking follicular disturbances. On histopathologic examinat ion, the follicular structures were dilated and hyperplastic with a peculia r dysplasia of the pilar matrix. Based on a review of the clinical, microsc opic, and investigational findings of the skin previously reported in assoc iation with her immunosuppressive drugs, are conclude that cyclosporine was the most likely causative agent. Moreover, hypertrichosis, dysmorphic faci es, and tissue hyperplasia have all been observed in patients during cyclos porine administration.