Bilateral Calcinosis Cutis of Orbital Walls in a Patient with Systemic Sclerosis

Purpose: Calcinosis cutis is the deposition of insoluble calcium salts in the cutaneous and subcutaneous tissue. Dystrophic calcification due to local tissue damage is the most common type of calcinosis cutis and is most commonly associated with autoimmune connective tissue diseases, particularly systemic sclerosis and dermatomyositis. Herein, we present a patient with systemic sclerosis who had complaints about subcutaneous yellow-white nodules on her lateral orbital rims. Methods: Interventional case report.Results: A 53-year-old female was referred for management of subcutaneous firm nodules on her lateral orbital rims. She was a known case of 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. Incisions were fashioned on the lateral orbital rims 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. Conclusion: Dystrophic calcinosis cutis develops in approximately 25% of patients with systemic sclerosis, particularly in those with the limited variant or CREST syndrome. The most frequently involved sites are the feet and hands (particularly fingers), followed by the extremities. Occasionally, calcinosis involves the trunk or head, but there are no previous reports of involvement of bony orbital walls in the literature, which makes this case unique.