ALBERT C.YANMD SAMIR S.SHAHMD
A 4-year-old black girl presented to the pediatric dermatology clinic for evaluation of a growth on the right foot, first noted in “early childhood.” Examination of the right heel revealed a well-circumscribed 3 × 5–mm white keratotic papule surrounded by a collarette of firm tissue with interruption of skin lines (Figure 1).
Well-circumscribed white keratotic papule on the right heel of a 4-year-old girl.
The lesion was assumed by the parents to be a wart and was treated with a topical salicylic acid preparation with complete resolution and subsequent recurrence within 1 month. The patient reported focal tenderness to pressure and discomfort while wearing shoes.
The child was born weighing 2090 g at 34 weeks’ gestation by an otherwise uncomplicated vaginal delivery. Apgar scores were 8 and 9, and although the initial physical examination results were normal, the child was taken to the nursery for observation. The postnatal course was complicated by poor feeding, temperature instability, and hyperbilirubinemia, resulting in a prolonged hospital course of 11 days. At the time of discharge, the patient was healthy, and subsequent medical history is otherwise unremarkable.
At the time of the visit, a shave biopsy was performed on the lesion, which showed subepidermal calcification consistent with calcinosis cutis (Figure 2).
Histopathologic analysis of a shave biopsy specimen showing subepidermal calcification (hematoxylin-eosin, original magnification ×40).
What is your diagnosis?
Braham SJ, Gilliam AE. Picture of the Month—Quiz Case. Arch Pediatr Adolesc Med. 2006;160(6):645. doi:10.1001/archpedi.160.6.645-a