Coexistence of Subepidermal Calcified Nodule and Keratosis Punctata in a Patient with Hyperhidrosis

Abstract

A 47-year-old female with hyperhidrosis developed multiple subepidermal calcified nodules and keratosis punctata on her palms. Although calcification was not detected on eccrine sweat glands around the calcified mass by histologic examination, it was supposed that the eccrine sweat glands may have played a role in inducing these two lesions in our case.

Subepidermal Calcified Nodule

“…The most favored theory is by Steigleder, who believed the calcium was deposited on a preexisting lesion such as a hamartoma or nevus (2). Other theories include the following: hamartomas of sweat duct origin whose cystic contents calcified; sweat gland structures in the presence of increased sweat calcium levels; mast cell degranulation with secondary calcification; traumatic calcification secondary to repetitive irritation; dystrophic calcification due to dermal injury; or calcium deposited in a milium, focal area of fat necrosis, old inflamed viral wart, or internal root sheath of a hair follicle (2,3,5). Hopefully in the future we will be able to ascertain the exact etiology and pathogenesis of this lesion.…”

Calcification in the apocrine glands of naevus sebaceus

“…Because skin is an important route for elimination of calcium from the body, eccrine sweat glands may be the initial sites of calcification, 3,4 but calcification in true apocrine glands derived from the follicular germ has not previously been reported, except for the mammary gland, which is a modified apocrine gland. van der Putte 5 described apoeccrine glands in naevus sebaceus, and stated that the apocrine glands in the apoeccrine glands developed from eccrine glands.…”