Case Report Miliary Osteoma Cutis: A Case Report Felipe Aguinaga, 1 Beatriz Trope, 1 Juan Piñeiro-Maceira, 2 and Marcia Ramos-e-Silva 3 1 Sector of Dermatology and Post-Graduation Course, School of Medicine and University Hospital, Federal University of Rio de Janeiro, 21941-913, Rio de Janeiro, RJ, Brazil 2 Sector of Pathology and Post-Graduation Course in Dermatology, School of Medicine and University Hospital, Federal University of Rio de Janeiro, 21941-913, Rio de Janeiro, RJ, Brazil 3 Sector of Dermatology, Sector of Dermatology and Post-Graduation Course, School of Medicine and University Hospital, Federal University of Rio de Janeiro, Rua Dona Mariana 143/C-32, 22280-020 Botafogo, RJ, Brazil Correspondence should be addressed to Marcia Ramos-e-Silva; ramos.e.silva@dermato.med.br Received 2 March 2014; Accepted 16 July 2014; Published 10 August 2014 Academic Editor: Toshiyuki Yamamoto Copyright © 2014 Felipe Aguinaga et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Te authors present a rare case of osteoma cutis miliaris and briefy update the current knowledge about its clinic, pathogenesis, and therapeutic options. 1. Introduction Miliary osteoma cutis is a rare entity, with just over 50 cases described in the literature [1]. It is characterized by the emergence of multiple fragments of mature bone in the dermis. Clinically, it presents as papules and normochromic hardened nodules similar to milia, which particularly afect the face, with a preference for women [1]. It may also occur as a late sequel in patients with acne vulgaris [2]. Te authors report a rare case of miliary osteoma cutis and briefy comment on the current knowledge about its clinical presentation, pathogenesis, and therapy. 2. Case Report A 62-year-old female patient complained about long standing lesions on the face. She denied any symptoms but wanted an aesthetic improvement of the lesions. She had a previous history of acne in adolescence without specifc treatment. Te examination showed several normochromic papules, hardened on palpation, grouped in the malar regions (Figure 1). Te very hard consistency of lesions caught our attention and this is why an ultrasound of the face was requested, which revealed small punctate echogenic spots with posterior acoustic shadowing, distributed difusely through the dermis of the cheek, which could correspond to calcium deposits. Laboratory tests revealed no changes in calcium metabo- lism or renal function. Histopathological examination showed a fragment of mature bone in the dermis, which became detached during the histologic processing, also containing bone marrow (Fig- ures 2 and 3). Tus, the fnal diagnosis was miliary osteoma cutis. As the patient refused to be submitted any surgical procedure, we chose to use retinoid acid cream at 0.1%. Afer 6 months of treatment, we did not notice any improvement in the number or appearance of the lesions. However, the patient was satisfed and believed that the lesions were less evident, and therefore did not want to undergo any complementary therapy. 3. Discussion Cutaneous ossifcation stages are rare and are divided into primary and secondary. Rare genetic syndromes, ofen pro- gressive and severe, are among the primary causes, each with phenotypic characteristics of their own, namely, progressive fbrodysplasia ossifcans, progressive osseous heteroplasia, Albright’s hereditary osteodystrophy, and plaque osteoma cutis [1–3]. Hindawi Publishing Corporation Case Reports in Dermatological Medicine Volume 2014, Article ID 347829, 3 pages http://dx.doi.org/10.1155/2014/347829