A 48-year-old woman requests evaluation of "bumpy" areas
on her face. The lesions are asymptomatic but had increased
in size and number during the previous four or five years.
The patient has no history of systemic disease and is not
taking any oral medications. She suffered from moderately
severe acne as a teenager and underwent dermabrasion twice
in her twenties to improve the residual facial scars. Examination
of her face reveals multiple, firm, whitish, dermal papules
that measure 1 to 3 mm each. Laboratory tests, including serum
calcium measurements, reveal no abnormalities.
The diagnosis is calcinosis cutis, a condition
caused by the deposition of calcium phosphate crystals within
the skin. Calcinosis cutis may be associated with an inflammatory
disease, such as acne, and has also been linked to previous
dermabrasion. When one of these precipitating factors is involved,
patients typically present with small, hard papules localized
to the cheeks and chin and with normal serum calcium levels.
Metastatic calcinosis, by contrast, rarely affects the skin
and is invariably associated with elevated serum levels of calcium,
phosphorus, or both. Surgical removal of the deposits, when
feasible, is the treatment of choice.
Dr. Schleicher is director of the DermDx Centers
for Dermatology of Northeastern Pennsylvania and a clinical instructor
of dermatology at Graduate Hospital's City Line Campus in Philadelphia,
kings College in Wilkes-Barre, and Beaver College in Glenside,
Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial
board.
