Miliary osteoma cutis of the face is a rare variant of osteoma cutis in which multiple fragments of bone are embedded in the skin. It has been reported in young women as a sequelae of severe acne or in older patients without a history of facial skin disease. See also osteoma cutis.
One study of 6500 CT scans of the head and neck [Dermatology Online Journal 2016;22;1] showed 2.27% had osteoma cutis of some type, with the multiple disseminated lesions (miliary type) far and away the most common (2%). Other variants described were as follows: multiple plate-like lesions, a single nodule, a single, plate-like lesions and a deep thread-like lesion.
Multiple flesh-colored papules of the face are characteristic. Calcium and phosphorus are normal. Blue-brown discoloration has occurred in patients treated with tetracycline or minocycline. Rarely, patients may develop multiple papular lesions on the trunk [AD 1998;134;641].
Ultrasound has been done, showing small punctate echogenic spots with posterior acoustic shadowing, distributed diffusely through the dermis of the cheek [Case Rep Dermatol Med. 2014; 2014: 347829].
Tretinoin may be tried when the lesions are small and superficial. Otherwise, surgical excision of each lesion may be done. This author usually picks 3-4 larger lesions for initial treatment as a test. Each area is cleansed and anesthetized. Then an #11 blade is used to make a small incision allowing the lesion be removed with forceps. Often the lesion is firmly adherent to the surrounding tissue and some amount of dissection/separation is needed. Suturing may or may not be needed, depending upon the size. The wounds are covered and allowed to heal. It cosmesis is satisfactory, more may be done. For a reference where a similar technique is used but with curettage, see J Am Acad Dermatol. 2001 Jan;44(1):96-9.
Alternatively complete excision of the affected skin with flap repair, dermabrasion, and CO2 laser excision have been reported. The erbium:YAG laser has been used with success in one patient [AD 1999;135;378]. The skin was vaporized to the level of the osteomas which were then easily rubbed off with gauze. A few required the use of a curette.
This is actually a case of calcinosis cutis but presenting in the same way with malarial lesions on the face. Of note, the case was imaged with a CT scan. Sahu SK, Gupta N, Vohra S. Calcinosis cutis secondary to facial acne vulgaris: A rare complication. Indian Dermatol Online J [serial online] 2015 [cited 2016 Jan 2];6, Suppl S1:37-9.
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