Multiple subepidermal calcified nodules on the eyelids with eruptive syringomas: a possible ethiopathogenic relationship

Abstract

generalized pustular eruption occurred 3 days after the delivery. A partial resolution was achieved with oral prednisolone (40 mg od) slowly tapered, but a satisfactory clinical response was only obtained with methotrexate (20 mg/week), leading to a complete resolution of the skin lesions at the 8th week of therapy. The newborn was a healthy male with no significant skin lesions.A new episode of generalized pustular eruption arose 1 year later, during the 20th week of an additional pregnancy. The patient was readmitted, and a very satisfactory clinical response was obtained with oral prednisolone (30 mg od), but a complete resolution was only observed 2 months after the delivery. The second son was also a male with no skin lesions until the age of 3 months, when he was observed with several well-demarcated erythematous plaques with superficial silver-white coloured crusts on the scalp and anterior aspect of lower limbs, clinically suggestive of plaquetype psoriasis.IH is a rare pustular eruption of pregnancy with unknown aetiology. It is frequently classified as a form of generalized pustular psoriasis, 1,2 and it normally occurs during the third trimester of pregnancy, significantly improving in the puerperium with possible recurrences in subsequent pregnancies. 3 It is associated with increased mother/foetal morbidity and mortality. 4 Systemic steroids are the mainstay of treatment. However, other drugs such as PUVA, retinoids and cyclosporin have been used either as single-agent or in combination therapies, particularly in poorly controlled disease. 5 The use of methotrexate in IH has been reported in three cases, two of them successfully. 3,5,6 Principally during the puerperium, a good outcome with methotrexate can be expected, as occurred in our patient.Several remarkable features have to be signalled in this case (i.e. the manifestation of the disease in a primigravida, the uncommon puerperal outbreak obligating to perform an aggressive systemic treatment, the recurrence during the second pregnancy at an early stage and the presence of psoriatic lesions in the second 3-monthold son). According to the clinical and histopathologic signs, the excellent response to methotrexate, which has proven efficacy in pustular psoriasis, and the coexistence of early onset psoriasis on the second son, we believe that IH can be really considered a variety of generalized pustular psoriasis. References1 Chang SE, Kim HH, Choi JH, Sung KJ, Moon KC, Koh JK. Impetigo herpetiformis followed by generalized pustular psoriasis: more evidence of the same disease entity. Int J Dermatol 2003; 42: 754-755. 2 Breier-Maly J, Ortel B, Breier F, Schmidt JB, Hönigsmann H. Generalized pustular psoriasis of pregnancy (impetigo herpetiformis). Dermatology 1999; 198: 61-64. 3 Katsambas A, Stavropoulos PG, Katsiboulas V et al. Impetigo herpetiformis during the puerperium. Dermatology 1999; 198: 400-402. 4 Brightman L, Stefanato CM, Bhawan J, Phillips TJ. Third-trimester impetigo herpetiformis treated with cyclosporine. J Am Acad Dermatol 2007; 56...

Eruptive syringomas associated with milia‐like idiopathic calcinosis cutis

“…This hypothesis is further reinforced by the association of SCN with either anhidrotic ectodermal dysplasia and the simultaneous presence of conventional palpebral syringomas and white verrucous palpebral nodules showing histologically calcium deposits consistent with the diagnosis of multiple SCN. 19 A similar "eccrine" hypothesis has been postulated in scrotal calcinosis in which the breakdown of dilated cystic ducts after dystrophic intaductal calcinosis may result in the absence of visible clear-cut cystic structures. 20 In conclusion, the characteristic distribution of dermal calcium deposits in MICC and its occasional association with generalized ESs seems to support the possible sweat duct origin of this uncommon and peculiar form of superficial calcinosis cutis.…”

“…A possible eccrine sweat gland origin as the initial site of deposition of calcium has also been suggested. This hypothesis is further reinforced by the association of SCN with either anhidrotic ectodermal dysplasia and the simultaneous presence of conventional palpebral syringomas and white verrucous palpebral nodules showing histologically calcium deposits consistent with the diagnosis of multiple SCN 19 . A similar “eccrine” hypothesis has been postulated in scrotal calcinosis in which the breakdown of dilated cystic ducts after dystrophic intaductal calcinosis may result in the absence of visible clear‐cut cystic structures 20 …”

Bilateral Symmetrical Subepidermal Calcified Nodules of the Eyelids

“…Only a few bilateral cases were reported in the literature, but symmetry of lesions were not as prominent as our case. 3,[7][8][9] The nodules of our case were measured 10 Â 7 mm in diameter on the right and 9 Â 6 mm on the left side, which were larger than those in the current literature (mean diameter, 3 mm; range, 1-5 mm). 1,3,5 The histopathologic features of SCN include homogenous basophilic subepithelial calcific deposits beneath the acanthotic, papillomatous epidermis in the upper dermis on haematoxylin-eosin-stained preparations.…”

Subepidermal Calcified Nodule on the Eyelid: A Case Report

“…Subepidermal kalsifiye nodül; idiopatik kalsinozis kutisin nadir görülen lokalize formunu temsil eder (1). İlk kez 1952 yılında Winer tarafından tanımlanmıştır (2).…”