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Calcified nodules of the heels - Skin in Child
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Calcified nodules of the heels - Skin in Child

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Contributors: Drew J. Klug BS, Jason E. Hawkes MD, Whitney A. High MD, JD, MEng, Sarah Stein MD, Karen Wiss MD, Sheila Galbraith MD, Craig N. Burkhart MD, Dean Morrell MD, Cynthia Christy MD, Nancy Esterly MD
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Synopsis

Calcified nodules of the heel represent dystrophic calcification of the skin (calcinosis cutis) following trauma, mostly due to needle sticks during in the neonatal period. Lesions occur in both normal infants and in high-risk neonates with a history of repeated heel sticks. It is believed alkaline phosphatase is released during the needle stick, leading to an altered local pH, with precipitation of calcium salts. Serum calcium and phosphate levels are normal.

Calcified nodules begin as small yellow to white nodules that slowly increase in size and migrate through the epidermis to the skin surface. Lesions typically appear between 4-12 months of age and often resolve spontaneously between 18-30 months. Most lesions are asymptomatic, but some may cause local irritation or pain.

Codes

ICD10CM:
L94.2 – Calcinosis cutis

SNOMEDCT:
255003 – Calcified nodule

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Subepidermal calcified nodule – solitary white to yellow papule or nodule typically on the head / neck (children) and extremities (adults)
  • Verruca vulgaris – hyperkeratotic, verrucous, white-to-tan-colored papule or plaque
  • Epidermal inclusion cyst – a well-circumscribed nodule with or without a central punctum
  • Molluscum contagiosum – small skin-colored or translucent papules with umbilication and/or a white central core
  • Milia – small white to yellow papules, typically on the cheeks and periorbital skin
  • Cutaneous horn – thick, columnar-like hyperkeratotic debris that arises from an actinic keratosis, verruca, squamous cell carcinoma, or keratoacanthoma
  • Pilomatricoma (calcifying epithelioma of Malherbe) – solitary, firm, skin-colored or bluish-appearing nodule or tumor often found upon the head / neck or upper extremities

Best Tests

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Therapy

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References

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Last Updated: 11/18/2015
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Calcified nodules of the heels - Skin in Child
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Calcified nodules of the heels : Heel, Needle stick exposure, Plantar foot, Verrucous scaly papules, Firm nodules
Clinical image of Calcified nodules of the heels
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