Calcified Cutaneous Nodules on the Heels of Children: A Complication of Heel Sticks as a Neonate

Abstract

We report the presence of calcified nodules on the heels secondary to heel sticks in healthy monozygotic twins in childhood. The subjects were born preterm at 34 weeks. The heels were normal at birth. While in the hospital, they underwent multiple heel sticks as a means of venesection. The wounds failed to heal normally and warty lesions developed. Calcified cutaneous nodules secondary to heel sticks have been reported primarily in high-risk, preterm infants. There have also been two reports of their development in normal healthy infants. To date, all reported lesions have been asymptomatic, with spontaneous resolution by 18-30 months. These cases indicate that such lesions can in fact be chronic, extending into childhood, when they may become symptomatic. Dermatologists should therefore consider this diagnosis as a cause of warty, calcified nodules on the heel in childhood as well as in infants and in neonates.

Calcified nodule on the heel of a child following a single heel stick in the neonatal period

“…described the development of small calcified heel nodules following multiple heel sticks for venesection in high‐risk neonates in intensive care units. Similar case reports 5–7 have followed.…”

“…Serum calcium and phosphate levels are normal 4,7 , 8 . Histopathologically, the lesions show small foci of irregular calcification in the upper dermis, surrounded by loose fibrous connective tissue and a mononuclear inflammatory infiltrate; these characteristics are similar to those of subepidermal calcified nodule of the face in children 4,6 . It is likely that the calcification is dystrophic following local tissue injury 4–6 .…”

“…Lesions are typically asymptomatic, often solitary, white or yellowish papules or nodules localized to the skin of the heel at the site of multiple heel sticks performed during the neonatal period 4–7 . The lesions are characteristically noticed several months after birth 4–7 . Transepidermal elimination with recurrence has been noted in a few patients 5,6 .…”

Cutaneous calcifications induced by heel pricks: Figure 1

“…X-ray may be required for confirmation. Spontaneous extrusion through the epidermis and recurrence are not uncommon 5. It is usually a self-limiting phenomenon and resolves spontaneously in 18–30 months but some cases may have a protracted course 3…”

Four cases of subepidermal calcified nodule on a child’s sole

“…Compared with the incisional biopsy, the Tzanck film examination is non‐infiltrating, quick, and simple, making it easy in cases where tissue biopsy is difficult, such as with newborns 8 . SCN can also be diagnosed with simple x‐ray examination when small radiopaque substances are observed 9 …”