calcinosis cutis is the pathologic deposition of insoluble calcium salt in the skin and subcutaneous tissue .
it is classified into four main subtypes : dystrophic , metastatic , idiopathic , and iatrogenic .
dystrophic calcinosis cutis follows inflammation , infection , connective tissue diseases , and so on .
complications of acne vulgaris such as calcinosis cutis are rarely reported previously in the literature .
a 55-year - old man who is a diagnosed case of obstructive sleep apnea ( osa ) presented with symptoms of sinusitis for a period of 15 days .
a computed tomography ( ct ) scan was done to confirm the diagnosis of sinusitis .
however , ct scan showed multiple soft tissue calcification distributed all over the face mainly in the region of distribution of acne vulgaris suggestive of calcinosis cutis [ figure 1 ] .
the patient was given antibiotics and supportive treatment for sinusitis after which he recovered completely .
he reported that he had severe acne vulgaris in his adolescence for which he did not take any treatment . on retrospective questioning
however , the patient also had multiple skin - colored papules of various sizes ranging from pin head to maximum of 5 mm over the face predominantly on cheeks [ figure 2 ] , nose , and forehead for a period of 25 years .
the plasma calcium , phosphate , vitamin d , and parathormone levels were within normal range .
however , all other hematological and biochemical investigations including complete blood count and peripheral smear , liver , kidney function tests , and urine microscopy were normal .
antinuclear antibody , rheumatoid factor , p- and c - anca , anti - topoisomerase , anticentromere antibodies , and hiv serology were negative .
computed tomography scan showing multiple soft tissue calcification distributed all over the face mainly in the region of distribution of acne vulgaris suggestive of calcinosis cutis a punch biopsy from the acne scars on the face showing areas of small calcific deposits in the upper - to - mid dermis a punch biopsy was done from the acne scars on the face , which showed areas of small calcific deposits in the upper - to - mid dermis .
multiple skin - colored papules of various sizes ranging from pin head to maximum of 5 mm over the left cheek
it is caused by abnormal follicular hyperkeratinization and overproduction of sebum by the sebaceous gland .
acne vulgaris affects nearly 80% of the population between 12 and 25 years  without gender , ethnicity , or race prevalence differences .
the pathophysiology of acne vulgaris includes increased sebum production , follicular hyperkeratinization , proliferation of propionibacterium acnes , and production of inflammation .
usually calcinosis cutis presents as multiple , hard , whitish papules , plaques , or nodules .
it is known to occur in a variety of disorders and classified into four subtypes according to its etiology : dystrophic , metastatic , iatrogenic , and idiopathic .
the term dystrophic calcinosis is used for calcification associated with infection , inflammatory processes , cutaneous neoplasm , or connective tissue diseases .
it is the most common type of ectopic calcification and develops around localized tissue damage , with no alterations of calcium or phosphate metabolism .
in contrast , metastatic calcification is characterized by abnormal calcium and/or phosphate metabolism that leads to the precipitation of calcium in cutaneous and subcutaneous tissue .
medical intervention can cause tissue damage or disturbances in calcium and phosphate metabolism , leading to soft tissue calcification in some cases known as iatrogenic calcinosis cutis . in a normal tissue ,
ectopic deposits of calcium salts develop when the calcium phosphate product in plasma exceeds 70 mg / dl .
however , in a damaged tissue the following pathogenic phenomena may play a role  increased intracellular calcium concentration , denaturation of proteins that preferentially bind phosphate , genetic mutations of elastic fibers and collagen , and increased g - carboxyglutamic acid .
calcinosis cutis is a rare disease , so there are no controlled clinical trials on its treatment .
various medical and surgical modalities have been found to be beneficial but none has been accepted as standard .
medical management include warfarin , bisphosphonates , minocycline , ceftriaxone , diltiazem , aluminum hydroxide , probenecid , intralesional corticosteroids , and intravenous immunoglobulin .
surgical modalities include curettage , surgical excision , carbon dioxide laser , and extracorporeal shock wave lithotripsy .
our patient had a history of acne lesions during puberty , following which scar lesions were present on his face .
however , despite an extensive search no relationship was found between osa and calcinosis cutis .
thus , it is concluded that dystrophic calcinosis cutis can develop rarely secondary to acne vulgaris .
 acne vulgaris is a common dermatological disease commonly affecting the adolescent and young adults . 
 it is characterized by the presence of pleomorphic skin lesions such as comadones , papules , pustules , and nodules . 
 the common complications are postacne hyperpigmentation and scarring causing psychological impact . 
 calcinosis cutis is the pathologic deposition of insoluble calcium salt in the skin and subcutaneous tissue . 
 calcinosis cutis following acne vulgaris is rarely reported in the literature . 
 we report a case of calcinosis cutis in acne vulgaris in a 55-year - old man . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION
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