Trichodysplasia spinulosa (TS) is a rare folliculocentric disease, first reported in 1995, 1, 2 and later named in 1999. 3 The key clinical manifestation of TS is keratin spines protruding through follicular openings, which have been termed spicules. 2 The centre of the face is the most frequently affected body site, but spicules can develop virtually anywhere or be disseminated throughout the skin. 4, 5 TS appears to occur exclusively in immunocompromised patients, most commonly following solid organ transplantation or immunosuppressive treatment for leukaemia.