REPORT OF A CASE
An 81-year-old retired nurse presented with a 2-year history of multiple, itchy lesions on her face. The lesions had not improved with topical imidazole and steroid creams, oral griseofulvin, and oral tetracycline. The patient was bathing her face with Dettol, a disinfectant containing chloroxylenol, as she was convinced that she had a fungal infection of the skin. She admitted to vigorously picking the lesions. Physical examination revealed multiple pale, hard papules 2 to 3 mm in diameter that were scattered over both cheeks up to the hairline. The surrounding skin was slightly erythematous and scaly (Figure 1).A punch biopsy specimen was taken from the right cheek.What is your diagnosis?
Multiple miliary osteoma cutis.
The hematoxylin-eosin—stained section showed islands of lamellar bone within the dermis surrounding marrow spaces containing adipocytes (Figure 2). New bone formation by osteoblasts was seen as was an occasional osteoclast.
Levell NJ, Lawrence CM. Multiple Papules on the Face. Arch Dermatol. 1994;130(3):373-374. doi:10.1001/archderm.1994.01690030107019