White Lesions In calcinosis cutis there are firm white to white-yellow papules with an irregular surface. When the contents are expressed, a chalky white material is seen. Dystrophic calcification is seen at sites of previous inflammation or damage to the skin. It develops in acne scars as well as on the distal extremities of patients with scleroderma and in the subcutaneous tissue and intermuscular fascial planes in DM. The latter is more extensive and is more commonly seen in children. An elevated calcium phosphate product, most commonly due to secondary hyperparathyroidism in the setting of renal failure, can lead. | Chapter 054. Skin Manifestations of Internal Disease Part 19 White Lesions In calcinosis cutis there are firm white to white-yellow papules with an irregular surface. When the contents are expressed a chalky white material is seen. Dystrophic calcification is seen at sites of previous inflammation or damage to the skin. It develops in acne scars as well as on the distal extremities of patients with scleroderma and in the subcutaneous tissue and intermuscular fascial planes in DM. The latter is more extensive and is more commonly seen in children. An elevated calcium phosphate product most commonly due to secondary hyperparathyroidism in the setting of renal failure can lead to nodules of metastatic calcinosis cutis which tend to be subcutaneous and periarticular. These patients can also develop calcification of muscular arteries and subsequent ischemic necrosis calciphylaxis . Skin-Colored Lesions There are several types of skin-colored lesions including epidermoid inclusion cysts lipomas rheumatoid nodules neurofibromas angiofibromas neuromas and adnexal tumors such as tricholemmomas. Both epidermoid inclusion cysts and lipomas are very common mobile subcutaneous nodules the former are rubbery and drain cheeselike material sebum and keratin if incised. Lipomas are firm and somewhat lobulated on palpation. When extensive facial epidermoid inclusion cysts develop during childhood or there is a family history of such lesions the patient should be examined for other signs of Gardner syndrome including osteomas and desmoid tumors. Rheumatoid nodules are firm to 4cm nodules that tend to localize around pressure points especially the elbows. They are seen in 20 of patients with rheumatoid arthritis and 6 of patients with Still s disease. Biopsies of the nodules show palisading granulomas. Similar lesions that are smaller and shorter-lived are seen in rheumatic fever. Neurofibromas benign Schwann cell tumors are soft papules or nodules that exhibit the button-hole .
