Indian Journal of Dermatology
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CORRESPONDENCE
Year : 2008  |  Volume : 53  |  Issue : 3  |  Page : 159-160
Idiopathic vulvar calcinosis: The counterpart of idiopathic scrotal calcinosis


Departments of Skin and STD, Kasturba Medical College, Manipal, Karnataka, India

Correspondence Address:
Vandana Mehta
Departments of Skin and STD, Kasturba Medical College, Manipal, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.43220

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How to cite this article:
Mehta V, Balachandran C. Idiopathic vulvar calcinosis: The counterpart of idiopathic scrotal calcinosis. Indian J Dermatol 2008;53:159-60

How to cite this URL:
Mehta V, Balachandran C. Idiopathic vulvar calcinosis: The counterpart of idiopathic scrotal calcinosis. Indian J Dermatol [serial online] 2008 [cited 2019 Dec 12];53:159-60. Available from: http://www.e-ijd.org/text.asp?2008/53/3/159/43220


Calcinosis cutis is characterized by the deposition of hydroxyapatite crystals of calcium phosphate in the skin. It is commonly encountered as a consequence of connective tissue disease or metabolic abnormalities but sometimes could be idiopathic. We report a case of idiopathic calcinosis cutis of the vulva in a healthy woman.

A 35-year-old woman presented with multiple asymptomatic yellowish nodules on the external genitalia of one year duration. A few of the nodules broke down spontaneously discharging a chalky white material. She was otherwise healthy and had no systemic complaints. There was neither a history of trauma nor any inflammatory process in the vulvar skin prior to the development of lesions. The hematologic and biochemistry panel such as liver and renal function, serum calcium, phosphorous, electrolytes, uric acid and parathyroid hormone levels were normal. An excision biopsy of the nodule showed features suggestive of calcinosis cutis [Figure 1].

Cutaneous calcification may be divided into four major categories: dystrophic, metastatic, iatrogenic and idiopathic. [1] Though dystrophic calcinosis is fairly common, idiopathic calcification is rare, and usually no underlying cutaneous cause can be identified. It commonly presents as painless, firm papules and nodules that appear in childhood and adolescence and gradually increase in number and size. Lesions may be solitary or pedunculated and are initially skin-colored, but as they grow larger they become yellowish and lobulated breaking down spontaneously or when compressed to produce a chalky white material. Microscopic examination typically shows large granular deposits of deeply basophilic material which stains black with Von Kossa stain for calcium. [2]

The pathogenesis of idiopathic vulvar calcinosis is highly disputed. The principle debate concerning the cause is whether calcium is deposited at the site of inflamed epidermal cysts or whether the calcific nodules are truly idiopathic. Although several authors have suggested that vulvar calcinosis results from dystrophic calcification of the inflammed epidermal cysts, several others have refuted the above facts and found it to be truly idiopathic. [3]

Idiopathic calcinosis cutis of the vulva is rare with only seven cases reported worldwide. Besides, it has also been reported over the neck after rhytidectomy, [4] the sctotal wall [5] , shaft of the penis [6] and the areola of the breast. [7] Cornelius et al, have postulated that tiny apatite crystals seen only on electron microscopy in cases of idiopathic calcinosis cutis might act as a source of injury leading to secondary deposition of acid mucopolysaccharides, which become a matrix for crystal formation and calcification. What initiates the deposition of these crystals is not yet known. [8] In our case no predisposing cause for calcification could be identified and since the patient was asymptomatic and not keen on surgical removal the lesions were not excised.

 
   References Top

1.Angamuthu N, Pais AV, Chandrakala SR. Calcinosis cutis: A report of four cases. Trop Doct 2003;33:50-2.  Back to cited text no. 1    
2.Walsh JH, Fairley JA. Calcifying disorders of the skin. J Am Acad Dermatol 1995;33:693-706.  Back to cited text no. 2    
3.Ozηelik B, Serin IS, Ba?buπ M, Oztürk F. Idiopathic calcinosis cutis of the vulva in an elderly woman: A case report. J Reprod Med 2002;47:597-9.  Back to cited text no. 3    
4.Aksoy HM, Ozdemir R, Karaaslan O, Tiftikcioglu YO, Oruη M, Kocer U. Incidental idiopathic calcinosis cutis in a rhytidectomy patient. Dermatol Surg 2004;30:1145-7.  Back to cited text no. 4    
5.Sαnchez-Merino JM, Bouso-Montero M, Fernαndez-Flores A, Garcνa-Alonso J. Idiopathic calcinosis cutis of the penis. J Am Acad Dermatol 2004;51:S118-9.  Back to cited text no. 5    
6.Oh CK, Kwon KS, Cho SH. Idiopathic calcinosis of the areola of the nipple. J Dermatol 2000;121-2.  Back to cited text no. 6    
7.Yahya H, Rafindadi AH. Idiopathic scrotal calcinosis: A report of four cases and review of the literature. Int J Dermatol 2005;44:206-9.  Back to cited text no. 7    
8.Cornelius CE, Tenenhouse A, Weber JC. Calcinosis cutis. Metabolic, sweat, histochemical, X- Ray diffraction and electron microscopic study. Arch Dermatol 1968;98:218.  Back to cited text no. 8    


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