Multiple cutaneous osteomas of the face associated with chronic inflammatory acne

Abstract

Multiple miliary osteoma cutis of the face represents a rare and frequently unrecognized complication of chronic inflammatory acne. Their differentiation from microcomedones and macrocomedones may be challenging. The case of a 46-year-old Asian woman who suffered from chronic inflammatory acne is described. She had multiple papular lesions of the cheeks that did not respond to various topical and systemic therapies including oral isotretinoin. Light microscopy studies as well as ultrasound and computed tomography (CT) scan investigations demonstrated the presence of multiple osteoma cutis. Needle microincisions followed by mechanical extirpation of the bony formation resulted in a considerable cosmetic improvement of her skin disease. Knowledge of this rare complication of acne is mandatory, as its treatment is different from that of retentional and inflammatory acne and frequently relies on surgical modalities. Our novel technique consisting of needle microincisions with curettage of the lesions is simple and safe, leading to good cosmetic results.

Lesões múltiplas de osteoma cutis na face: terapêutica minimamente invasiva em pacientes com sequela de acne - relato de casos

“…They are benign tumours, of mature bone tissue, 4 that are located in the dermis and hypodermis and the majority of them is clinically asymptomatic. 4,10 In macroscopy they appear as irregular, hardened small nodules in the sujacent dermis, well circumscribed 7 and generally they are the same colour of the skin. Patients treated with tetracycline or minocycline can develop bluish 8,12 pigmented nodules.…”

“…Patients treated with tetracycline or minocycline can develop bluish 8,12 pigmented nodules. 3,10,11 They are found in patients from both sexes, different age groups and different races. 7,9 Occurences within some families suggest genetic factors.…”

Facial miliary osteoma in HIV patient

“…4 The primary ossification is believed to occur when there is no previous tissue injury, it may be associated with syndromes such as: Albright's hereditary osteodystrophy, progressive osseous fibrodysplasia and progressive osseous heteroplasia. 4,5 Secondary ossification, the most common form, occurs on skin areas which were previously affected by inflammatory or infectious processes, such as acne vulgaris, scars and tumors (pilomatrixoma, basal cell carcinoma, desmoplastic malignant melanoma, chondroid syringoma, among others), it may be more rarely associated to chronic inflammatory processes such as dermatomyositis, systemic sclerosis and ossifying myositis. 3,4 Despite the division into primary and secondary osteomas, the causal relationship between the presence of previous inflammation on skin and the onset of miliary osteoma on the face is not fully understood.…”

“…4,5 Secondary ossification, the most common form, occurs on skin areas which were previously affected by inflammatory or infectious processes, such as acne vulgaris, scars and tumors (pilomatrixoma, basal cell carcinoma, desmoplastic malignant melanoma, chondroid syringoma, among others), it may be more rarely associated to chronic inflammatory processes such as dermatomyositis, systemic sclerosis and ossifying myositis. 3,4 Despite the division into primary and secondary osteomas, the causal relationship between the presence of previous inflammation on skin and the onset of miliary osteoma on the face is not fully understood. 1 The FMO has been reported mainly in fair-skinned middle-aged women, in most cases with a previous background of acne, one previous case was described in the Brazilian literature.…”

“…1,2 The facial miliary osteoma (FMO) is characterized by the presence of multiple osteomas, affecting mainly young middle-aged women, with a previous background of acne. 1,[3][4][5] We report the case of a patient with the human immunodeficiency virus (HIV) with FMO.…”