10.5826/dpc.1203a108
text/xml
2160-9381
2079
en
Arun Inamadar
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
heel-stick injury
Clinical, dermoscopic and radiological features of heel stick calcinosis cutis: Clinical, dermoscopic and radiological features of heel stick calcinosis cutis
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-07-28
2021-09-28
2022-07-28
2022-09-13
e2022108
Dermatol Pract Concept
Arun Inamadar
2022/07/28
10.5826/dpc.1203a108
e2022108
Department of Dermatology, Venereology and Leprosy, Shri B M Patil Medical College Hospital and Research Centre, BLDE (Deemed to be University), Karnataka, India
2160-9381
heel-stick injury
en
e2022108
Clinical, dermoscopic and radiological features of heel stick calcinosis cutis: Clinical, dermoscopic and radiological features of heel stick calcinosis cutis
https://dpcj.org/index.php/dpc/article/download/2079/1648
                    Dermatology Practical & Conceptual


     Clinical, Dermoscopic and Radiological Features
                of Heel Stick Calcinosis Cutis
                                     Keshavmurthy A. Adya1, Arun C. Inamadar1


1 Department of Dermatology, Venereology and Leprosy, Shri B M Patil Medical College Hospital and Research Centre, BLDE (Deemed to be
  University), Karnataka, India



Key words: calcinosis cutis, dystrophic calcification, dermoscopy, heel-stick injury
Citation: Adya KA, Inamadar AC. Clinical, dermoscopic and radiological features of heel stick calcinosis cutis.
Dermatol Pract Concept. 2022;12(3):e2022108. DOI: https://doi.org/10.5826/dpc.1203a108
Accepted: November 8, 2021; Published: July 2022
Copyright: ©2022 Adya et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License
(BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/ which permits unrestricted noncommercial use, distribution, and
reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Arun C. Inamadar MD, Department of Dermatology, Venereology and Leprosy, Shri B M Patil Medical College
Hospital and Research Centre, BLDE (Deemed to be University), Vijayapur 586101, Karnataka, India, E-mail: aruninamadar@gmail.com




Introduction                                                              was made. Plain X-ray revealed multiple white opacities
                                                                          within the soft tissues of the heels (Figure 1C). One of the
Heel-stick calcinosis is a common disorder of infants due                 lesions was punctured and chalky white material was ex-
to heel prick injury. Although the condition is benign and                pressed out which was dissolved by hydrochloric acid sug-
self-resolving, it may cause anxiety and concern to the par-              gesting that it was calcium hydroxyapatite (Figure 2, A-C).
ents. Dermoscopy allows non-invasive confirmation of the                  Laboratory tests for calcium, phosphorous and vitamin D
diagnosis and differentiates other disorders with similar                 were all normal. A final diagnosis of dystrophic calcinosis
morphology thus helping in reassuring the parents.                        cutis following heel-stick injury was hence established. As
                                                                          the condition is self-limiting, the parents were reassured
                                                                          about the same.
Case report
An 8-month-old male was brought to us with multiple
                                                                          Conclusions
whitish lesions on the soles of both the feet since the past 4
months. On enquiry, parents revealed multiple heel pricks                 Heel-stick calcinosis is a form of dystrophic calcification
done for blood tests in the past. Examination revealed                    following heel pricks. Multiple pricks account for majority
multiple discrete porcelain-white papules and carateriform                of the cases although cases following single prick have also
keratotic papules (Figure 1A). Polarized dermoscopy using                 been described. Release of alkaline phosphate by injured tis-
handyscope (FotoFinder® systems GmbH) revealed 2 types                    sue elevates the local pH favoring calcium deposition. The
of lesions - homogenous circumscribed white clods and ker-                lesions can be solitary, or multiple discrete yellow-white
atotic lesions showing central amorphous yellow and white                 papules or nodules and keratotic lesions which may be seen
clods surrounded by thick concentric scales (Figure 1B). A                extruding through the epidermis. The lesions usually regress
diagnosis of calcinosis cutis secondary to heel stick injury              within about 2-3 years of age [1].



Research Letter | Dermatol Pract Concept. 2022;12(3):e2022108                                                                         1
     Figure 1. Dermoscopy: polarized, x20. (A) Multiple discrete white and keratotic papules on the heels. (B) Dermoscopy shows well-
     defined homogenous white dots (black arrows) and keratotic lesions with central yellow and white amorphous clods surrounded by
     concentric thick scales (blue arrows). (C) Plain X-ray shows circumscribed opaque densities along the margins of the heel




    Figure 2. (A) Chalky-white material expressed out of a papule. (B) Material as observed under light microscope. (C) Complete dissolu-
    tion of the material was seen on treatment with hydrochloric acid.



     Dermoscopy of calcinosis cutis exhibits homogenous                 described above. It is mostly associated with Down syn-
white areas as described above. The dermoscopy of kera-                 drome characterized by discrete white papules involving
totic lesions as described above highlights the process of              hands and feet.
trans-epidermal elimination of calcium deposits. Warts, cal-                Although a fairly well-known entity and the diagnosis es-
losities and corns can present as keratotic papules on the              sentially clinical, application of dermoscopy in the diagnosis
soles. Dermoscopically they show compact keratin, and                   of heel stick calcinosis provides further support and refutes
the warts in addition show red or black dots surrounded                 the need for biopsy and/or radiological imaging.
by white halo. These lesions are rare in infants and do not
show white homogenous material. Porokeratotic eccrine
                                                                        References
ostial and dermal duct nevus (PEODDN) presents with
keratotic papules with collarette typically involving palms              1. Braham SJ, Gilliam AE. Picture of the month: calcified nod-
and soles and presenting at birth or in early childhood. The                ule secondary to heel sticks. Arch Pediatr Adolesc Med.
                                                                            2006;160(6):645. DOI: 10.1001/archpedi.160.6.645-a. PMID:
lesions are grouped and frequently along the Blaschko lines.
                                                                            16754828.
Dermoscopy of PEODDN on palmar skin showing keratin
                                                                         2. Gupta AK, Agrawal A, Rambhiya K, Makhecha M. Generalized
filled pits has been described [2]. Hence, discrete lesions and             unilateral porokeratotic eccrine ostial and dermal duct nevus
presence of amorphous white substance centrally differenti-                 along the lines of blaschko: A rare entit. Indian J Dermatopa-
ates heel-stick calcinosis from PEODDN. Finally, milia-like                  thol Diagn Dermatol. 2019; 6:51-52. DOI: 10.4103/ijdpdd.
calcinosis cutis exhibits similar dermoscopic features as                    ijdpdd_47_18.




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