Osteoma Cutis Clinical Presentation

  • Author: Kevaghn P Fair, DO; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 24, 2012
 

History

  • Patients may report having hard areas in the skin.
  • A familial occurrence of Albright hereditary osteodystrophy may be present.
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Physical

  • The presentations of osteoma cutis can be highly variable, with clinical entities that are defined by the number, the form, and the location of the lesions.
  • Osteomas may present as single or multiple, extremely hard nodules, plaques, or miliary tumors.[3]
  • The face, the extremities, the scalp, the digits, and the subungual regions are the most commonly affected sites.
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Causes

Osteoma cutis is a feature in several groups of patients.

  • Albright hereditary osteodystrophy, which includes most patients with pseudohypoparathyroidism and pseudopseudohypoparathyroidism, is due to an autosomal dominant defect in the alpha subunit of intracellular guanyl nucleotide-binding protein (G protein).[4]
    • The characteristic phenotype includes short stature, a round face, defective teeth, mental retardation, brachydactyly, and osteomas of the soft tissue and the skin.
    • Tetany is often the presenting sign of pseudohypoparathyroidism, formerly called Albright hereditary osteodystrophy. In addition to skeletal system abnormalities, lesions of osteoma cutis are frequently observed.
  • Single, small osteomas, arising later in life, sometimes with transepidermal elimination of bony fragments may be a cause.
  • Multiple miliary osteomas of the face following acne, neurotic excoriation, or dermabrasion are possible causes.[5]
  • Congenital plaquelike osteomatosis or limited dermal ossification is generally present from birth; the skin of the scalp or the extremities is often affected.
  • Fibrodysplasia ossificans heteroplasia and fibrodysplasia ossificans progressiva are possible causes.
  • Miscellaneous rare disorders with or without cartilaginous elements include osteomas of the distal extremities and multiple osteomas of childhood unrelated to Albright hereditary osteodystrophy.
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Contributor Information and Disclosures
Author

Kevaghn P Fair, DO  Consultant Pathologist and Founder, Dominion Pathology Laboratories

Kevaghn P Fair, DO is a member of the following medical societies: American Society for Clinical Pathology, American Society of Dermatopathology, and College of American Pathologists

Disclosure: Nothing to disclose.

Specialty Editor Board

James W Patterson, MD  Professor of Pathology and Dermatology, Director of Dermatopathology, University of Virginia Medical Center

James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Dermatopathology, Royal Society of Medicine, Society for Investigative Dermatology, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

References

  1. Burgdorf W, Nasemann T. Cutaneous osteomas: a clinical and histopathologic review. Arch Dermatol Res. Dec 12 1977;260(2):121-35. [Medline].

  2. Roth SI, Stowell RE, Helwigeb. Cutaneous ossification. Report of 120 cases and review of the literature. Arch Pathol. Jul 1963;76:44-54. [Medline].

  3. Cohen PR, Tschen JA, Schulze KE, Martinelli PT, Nelson BR. Dermal plaques of the face and scalp. Platelike osteoma cutis. Arch Dermatol. Jan 2007;143(1):109-14. [Medline].

  4. Ward S, Sugo E, Verge CF, Wargon O. Three cases of osteoma cutis occurring in infancy. A brief overview of osteoma cutis and its association with pseudo-pseudohypoparathyroidism. Australas J Dermatol. May 2011;52(2):127-31. [Medline].

  5. Riahi RR, Cohen PR. Multiple miliary osteoma cutis of the face after initiation of alendronate therapy for osteoporosis. Skinmed. Jul-Aug 2011;9(4):258-9. [Medline].

  6. Altman JF, Nehal KS, Busam KJ, Halpern AC. Treatment of primary miliary osteoma cutis with incision, curettage, and primary closure. J Am Acad Dermatol. Jan 2001;44(1):96-9. [Medline].

  7. Kim SY, Park SB, Lee Y, Seo YJ, Lee JH, Im M. Multiple miliary osteoma cutis: treatment with CO(2) laser and hook. J Cosmet Laser Ther. Oct 2011;13(5):227-30. [Medline].

  8. Cohen AD, Chetov T, Cagnano E, Naimer S, Vardy DA. Treatment of multiple miliary osteoma cutis of the face with local application of tretinoin (all-trans-retinoic acid): a case report and review of the literature. J Dermatolog Treat. Sep 2001;12(3):171-3. [Medline].

  9. Baskan EB, Turan H, Tunali S, Toker SC, Adim SB, Bolca N. Miliary osteoma cutis of the face: treatment with the needle microincision-extirpation method. J Dermatolog Treat. 2007;18(4):252-4. [Medline].

  10. Ragsdale BD. Lever's Histopathology of the Skin. Philadelphia, Pa: Lippincott-Raven; 1997:965-7.

  11. Watsky KL. Arndt KA, ed. Cutaneous Medicine and Surgery. Philadelphia, Pa: WB Saunders; 1996:1828-31.

  12. Weedon D, ed. Skin Pathology. 2nd ed. New York, NY: Churchill Livingstone; 2002:355-7.

 
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A microscopic view of osteoma cutis shows well-formed mature trabecular bone just beneath the epidermis. Note the absence of hematopoietic elements in the medullary spaces.
Solitary nodule on the frontal part of the scalp.
Miliary cutaneous osteomata. Multiple, small, bluish, stony-hard nodules in an acneiform distribution along the cheeks.
 
 
 
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