Perforating plate-like osteoma cutis in a man with solitary morphoea profunda

Abstract

Solitary morphoea profunda is an unusual form of scleroderma, characterized by marked fibrosis, hyalinization of collagen fibres, and inflammatory cell infiltration in the deep dermal and subcutaneous layers. We describe a 58-year-old man showing solitary morphoea profunda. Plate-like osteoma cutis, with transepidermal elimination of bony material, within the morphoea profunda, was present.

Primary Atrophic Solitary Morphea Profunda

“…Intense inflammatory cellular infiltrate, predominantly of mononuclear cells in the reticular dermis and subcutis, have also been reported [4]. Moreover, there have been reports of osteoma cutis occurring in SMP [7, 12]. In our case, collagen deposition with thickened hyalinized collagen bundles in the lower dermis was observed.…”

“…SMP, a condition first described by Whittaker et al in 1989 [4], is extremely rare [4,5,6,7,8,9]. Patients with SMP are usually middle-aged with an approximately equal sex distribution.…”

“…In the latter case, penicillin [5], topical tacrolimus [9], local steroid injections [8], excision and skin grafting [7] have been tried with variable and inconsistent results. In our case, superpotent topical steroids had little effect.…”

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

“…4 Pathogenicity is still not conclusive.The most accepted theory 13 refers to local metaplasia of mesenchymal cells such as fibroblasts producing bone tissue, 5 by the probability of alteration in the oxigen tension, ph, enzymatic activity, high activity of alkaline phosphatase, local concentrations of calcium and phosphorus, 2,6,14 presence of collagens type I 10 and III and TGF‚. 13 Another theory mentions an embryologic disorder with the primitive mesenchymal cells differentiated into osteoblasts wrongly migrating to other places. 1,5 Various authors 2,15 affirmed that the first case of osteoma cutis was described by WILKINS in 1858.…”

“…The secondary or metaplastic one occur as consequence of previous lesions, inflammatory diseases of the dermis, dermatomyositis, morphea, progressive systemic sclerose, CREST syndrome, basal cell carcionoma and Malherbe's calcified epithelioma, traumas, scars and application of intralesional corticoids for long periods of time in keloids. They represent from 80 to 85% of the cases 1,3,4,6,8,9,13,14 Not all osteomas can be clearly categorized. 8 The osteoma cutis miliary, can be classified in both groups: as it is not related to hypercalcemia or calcinosis, it could be classified as primary, but with precedent inflammatory processes it would be classified as secondary 4 The option, in this present work that is to diagnose osteoma cutis only in patients with acne sequela was due to the fact that various authors noted a correlation between the severity of acne and the presence of osteomas.…”