Bilateral calcinosis cutis of orbital walls in CREST syndrome

To describe a patient with systemic sclerosis who presented with subcutaneous yellow-white nodules on her lateral orbital rims.

Case report.

A 53-year-old female was referred for management of subcutaneous firm nodules on her lateral orbital rims. She was known to have CREST (calcification, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome, a limited variant of systemic sclerosis. Her drug history included diltiazem, captopril, aspirin, and prednisolone. There were bilateral multiple immobile yellow-white subcutaneous nodules with firm consistency, a few of which were in close proximity of periorbital skin. She was scheduled for surgical resection of the lesions and following tissue dissection, the calcified foci were removed. The incisions healed with some delay but the final postoperative follow-up at third month showed satisfactory appearance.

Dystrophic calcinosis cutis occurs in approximately one-fourth of patients with systemic sclerosis (scleroderma), particularly in those with the limited variant or CREST syndrome. The most frequently involved sites are the extremities. Occasionally, calcinosis involves the trunk or head, but involvement of bony orbital walls is extremely rare. Surgical excision can be considered for treatment of discrete foci of calcinosis cutis.