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| Year : 2022 | Volume
: 67
| Issue : 6 | Page : 832-833 |
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| Multiple firm papules on the face of a young man |
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Johanna Marcillo-Alvarez1, Alejandra Tomás-Velázquez2, Javier Antoñanzas2, Rafael Salido-Vallejo2
1 From the Department of Clinical Dermatovenerology, Peoples' Friendship University of Russia Medical Institute, Moscow, Russia
2 Department of Dermatology, University Clinic of Navarra, Pamplona, Spain
| Date of Web Publication | 23-Feb-2023 |
Correspondence Address:
Rafael Salido-Vallejo
Department of Dermatology, University Clinic of Navarra, School of Medicine, University of Navarra, Avda. Pio XII, 36 31008, Pamplona
Spain
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.ijd_388_21
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How to cite this article:
Marcillo-Alvarez J, Tomás-Velázquez A, Antoñanzas J, Salido-Vallejo R. Multiple firm papules on the face of a young man. Indian J Dermatol 2022;67:832-3 |
How to cite this URL:
Marcillo-Alvarez J, Tomás-Velázquez A, Antoñanzas J, Salido-Vallejo R. Multiple firm papules on the face of a young man. Indian J Dermatol [serial online] 2022 [cited 2023 Mar 23];67:832-3. Available from: https://www.e-ijd.org/text.asp?2022/67/6/832/370296 |
A 23-year-old healthy man presented with a 3-year history of slowly progressive multiple papules over his left temporal region. There was no history of acne, folliculitis, previous trauma or other causes. On facial examination, he presented with multiple, asymptomatic, skin-colored, and indurated papules of 2–4 mm in diameter localized on the left temporal region [Figure 1]. Physical examination did not reveal any other abnormalities. | Figure 1: Multiple, small, firm papules on the left temporal region on a young man
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A skin biopsy obtained from one papule revealed calcified bone formation in the dermis consisting of lamellar bone [Figure 2]. Laboratory examinations including calcium, phosphate, alkaline phosphatase and parathormone showed no abnormalities. | Figure 2: Bone formations in the dermis and hypodermis consisting of lamellar bone. (haematoxylin and eosin, ×40 magnification)
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 Histological Findings | |  |
Histopathological examination using haematoxylin-eosin staining reveals that bone formations exist in the dermis and hypodermis consisting of lamellar bone. Central bone formation with the presence of osteocytes, Haversian systems and hydroxyapatite eosinophilic.
| What is Your Diagnosis? | | |
Diagnosis
Multiple miliary osteomas cutis (MMOC).
| Discussion | | |
Multiple miliary osteoma cutis is a variant of primary osteoma cutis usually localized on the facial skin; first described by Virchow in 1864. It is defined as multiple lesions of bone tissue located in the dermis or hypodermis, normally it appears in middle age in healthy skin. Furthermore, they are described as having an association with past acne lesions.
The etiology and pathogenesis of MMOC are poorly understood.[1],[2] There are several cases reported in the literature,[1] however, some authors suggest that it may be an overlooked condition. In a dataset of 1315 cases of sinus Tomography computerized (CT), the prevalence of facial calcified nodules was 42.1%. These findings suggest that the real incidence of MMOC could be much higher.[3]
Although its diagnosis is clinical, ultrasonography has been proposed as a non-invasive method that may help with the diagnosis by showing microcalcifications of 0.1 to 10 mm in diameter in the dermis.[4] The procedures of treatment for this condition are multiple: Topical, systemic, surgical excision, ablative and Q-switched lasers have been described.[5]
Treatment must be carefully chosen based on the evaluation of each patient, the location of the lesions and the desired aesthetic results. MMOC is a benign and incidental presentation, has been underdiagnosed in the past, so this diagnosis should be taken into account on firm, asymptomatic lesions, refractory to previous treatments located on the face.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Learning points
- Multiple miliary osteoma cutis is a variant of primary osteoma cutis.
- MMOC are multiple lesions of bone tissue located in the dermis or hypodermis.
- Real incidence of MMOC could be underestimated in daily practice.
- The diagnosis is clinical, although recently ultrasonography has been proposed as a non-invasive method that may help with the diagnosis.
- The treatments that can be applied in this pathology included: Topical and systemic treatment, surgical excision, ablative and Q-switched lasers.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Thielen AM, Stucki L, Braun RP, Masouyé I, Germanier L, Harms M, et al. Multiple cutaneous osteomas of the face associated with chronic inflammatory acne. J Eur Acad Dermatol Venereol 2006;20:321-6.  |
| 2. | Duarte BM, Pinheiro RR, Cabete J. Multiple miliary osteoma cutis: A comprehensive review and update of the literature. Eur J Dermatol 2018;28:434-9. |
| 3. | Kim D, Franco GA, Shigehara H, Asaumi J, Hildenbrand P . Benign miliary osteoma cutis of the face: A common incidental CT finding. AJNR Am J Neuroradiol 2017;38:789-94. |
| 4. | Jaouen F, Tallegas M, Treffandier O, Patat F, Vaillant L, Machet L. High-frequency ultrasonography helps to confirm the diagnosis of multiple miliary osteoma cutis. Eur J Dermatol 2019;29:336-7. |
| 5. | Barolet AC, Litvinov IV, Barolet D. Multiple miliary osteoma cutis treatment response to Q-switched Nd: YAG laser: A case report. SAGE Open Med Case Rep 2020;8:2050313X20910562. |
[Figure 1], [Figure 2] |
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