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Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.

Volume 32, Number 10—October 2026

Evaluation of Trichodysplasia Spinulosa Polyomavirus in Skin Biopsies, United States

Ivan M. Espinal, Gregory W. Charville, Lauren Lawrence, Ryanne A. Brown, Kerri E. Rieger, and Sebastian Fernandez-Pol

Author affiliation: Stanford University, Stanford, California, USA (I.M. Espinal, G.W. Charville, R.A. Brown, K.E. Rieger, S. Fernandez-Pol); Guardant Health, Palo Alto, California, USA (L. Lawrence); Stanford Medicine, Stanford (R.A. Brown, K.E. Rieger)

Main Article

Cases evaluated for trichodysplasia spinulosa polyomavirus using RNAscope in situ hybridization, United States*

Case	Diagnosis	PPIB control probe result	TSPyV probe result	Days from steroid dose to biopsy
Control	Trichodysplasia spinulosa	Positive	Positive	Not applicable
1	Medium vessel vasculitis with epidermal necrosis and fibrinoid degeneration of superficial vessels (favor polyarteritis nodosa)	Positive	Negative	No steroid use
2	Erythema nodosum	Positive	Negative	No steroid use
3	Erythema nodosum	Positive	Negative	No steroid use
4	Erythema nodosum	Positive	Negative	No steroid use
5	Superficial and deep perivascular inflammation with eosinophils (favor resolving erythema nodosum)	Positive	Negative	No steroid use
6	Leukocytoclastic vasculitis	Positive	Negative	No steroid use
7	Leukocytoclastic vasculitis	Positive	Negative	No steroid use
8	Leukocytoclastic vasculitis	Positive	Negative	<1
9	Leukocytoclastic vasculitis	Positive	Negative	<1
10	Leukocytoclastic vasculitis	Positive	Negative	No steroid use
11	Interface dermatitis with eosinophils	Positive	Negative	10
12	Interface dermatitis	Positive	Negative	<1
13	Interface dermatitis with increased dermal mucin	Positive	Negative	No steroid use
14	Interface dermatitis	Positive	Negative	7
15	Interface dermatitis	Positive	Negative	<1
16	Interface dermatitis	Positive	Negative	<1
17	Perniosis	Positive	Negative	1,949
18	Perniosis	Positive	Negative	<1
19	Consistent with calciphylaxis	Positive	Negative	No steroid use
20	Epidermal ulceration with mixed inflammation and background stasis changes	Positive	Negative	No steroid use
21	Vasculopathy with focal calcium deposition (favor vasculopathy)	Positive	Negative	No steroid use
22	Ulceration with dermal necrosis, focal intravascular fibrin, and focal subtle calcium deposits (favor vasculopathy)	Positive	Negative	1
23	Neutrophilic panniculitis with fibrin thrombi and focal vessel wall calcification (favor Sweet syndrome)	Positive	Negative	1,494
24	Tumid lupus	Positive	Negative	108
25	Superficial and deep perivascular and periadnexal lymphocytic infiltrate with focal overlying vacuolar interface change and dyskeratosis, compatible with lupus	Positive	Negative	<1
*PPIB, peptidylprolyl isomerase B RNA; TSPyV, trichodysplasia spinulosa polyomavirus

Main Article

Page created: August 13, 2026

Page updated: September 21, 2026

Page reviewed: September 21, 2026

The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.

Volume 32, Number 10—October 2026

Research Letter

Evaluation of Trichodysplasia Spinulosa Polyomavirus in Skin Biopsies, United States

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