[2] Despite its rarity, TS is believed to be underdiagnosed, and the growing population of patients on immunosuppressive drug regimens suggests its incidence may rise.

[4] The disease is characterized by flesh-colored to erythematous (reddened) papules occurring in the central region of the face and sometimes elsewhere on the body, often accompanied by protrusive "spicules" or spines made of keratin and by alopecia of affected skin, typically the eyebrows and sometimes the eyelashes or scalp hairs.

[3][7][8] TSPyV infects the skin, but viral DNA is rarely detectable there in asymptomatic individuals even if they possess antibodies to the virus indicating exposure.

[3] There is limited evidence implicating the large tumor antigen as responsible for inducing cellular proliferation through pathways involving phosphorylated retinoblastoma protein (pRB).

Characteristic histological findings include enlarged and abnormally organized hair follicles and hyperproliferation of inner root sheath cells containing large eosinophilic trichohyalin granules.

[2] A proposed classification system lists TS as one of a group of cutaneous conditions with similar manifestations and distinct etiologies, collectively called the digitate keratoses.

This pattern is consistent with the behavior of other viral diseases found in immunocompromised patients, most relevantly with the nephropathy associated in kidney transplant recipients with the polyomavirus BK virus.

[3][13] A subsequent report in 1999, which introduced the term "trichodysplasia spinulosa", used electron microscopy to identify the presence of virus particles in affected cells consistent with what were at the time known as papovaviruses.