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Hard Colourless Bumps Under The Skin? Please Read - Post Acne Osteoma Cutis

Hi there, I am quite new still with this blogging so please be patient - hopefully this will get to all of you who need to read this.

This is especially relevant to those who have these under the skin bumps who have been on roaccutane - as this is apparently what caused mine - typical that a cure leads to a new problem but we are simply guinea pigs to be honest and who was to know... anyway, hopefully this is a helpful blog for you all....

I have had acne since I was 14, my chin and jawline being the main area - went on roaccutane when I was 16 or so and it cleared. It then came back when I was around 25 or so but not as bad. I then went on roaccutane once again. During the last 4 months of treatment i started getting small whitish, hard bumps under my skin. They were most noticable in sunlight and to touch, but they were not inflammed in anyway. The derm had no idea what is what and infact said it was commedonal acne - it looks like this, except you cannot squeeze them, they do not respond to any topical treatment and they are much harder to touch. I coped with this for over 2 years, they didn't seem to get worse. However, in sunlight it was horrific and I started getting v paranoid. So I went to a new Derm - Dr Edward Seaton at the St Johns Wood Hospital in London - he tried hyfrecation which did nothing but make me look horrifc for a week ( if it was comedonal acne it would have cleared - so all those who are suffing from this, hyfrecaton is what you need) and then topical retinoids. No response. So, he sent me for a biopsy. The pathology report was as follows;

I've reviewed your pathology slides with my colleagues. I think you have developed a rare complication of acne called 'post-acne osteoma cutis'. This causes the development of small blue-white calicfied lumps in the skin which actually represent tiny foci of ectopic bone formation. It has been reported following severe acne or after the use of tetracycline antibiotics, but not as far as I am aware after roaccutane or hair plucking. It in itself is a harmless condition that would not be expected to worsen, but is obviously distressing because of its cosmetic appearance. I think the only truely effective treatment here is likely to be surgical, by making a tiny incision over each lesion and removing each lump by scooping them through the nick. This would obviously leave some scarring, but it is likely to be minimal, would improve with time and would be easy to cover with make up. Laser therapy would I believe also not help significantly. Another option is the continued use of a topical retinoid treatment (such as differin) which helped in one report, but I would be surprised if it helped in your case and if it did so would take many months at least. We can talk further about this next week. If you decide to undertake treatment, I would stronly suggest we just treat one or two initially and then wait for 2-3 months to establish whether you are happy wioth the outcome before we treat all the lesions'

Dr Edward Seaton has been truly amazing - I had my first excision 4 weeks ago, where 30 or so were removed - the scarring is so minimal you simply cannot see any marks and the bumps have smoothed by at least 70%. I had another treatment on Monday and I do not expect to have to go back.

The message I would like to give to you all is that if your 'bumps' are not responding to 'normal treatment' and you cannot extract anything from them, then you really need to go for a biopsy - it sounds a lot worse than it is, you do not feel it and they will take a tiny bump ( one less there which is great right!) asap. Only with a pathology report will you know exactly what they are. When you know what they are, you can treat them. I must say it was truly amazing to have these bumps for the last 2 years suddenly disappear literally overnight, my skin surface is smooth and that is literally amazing for anyone who has suffered like I have...

The problem is that this is so rare it goes undetected and unrecognised - I am Dr Edward Seatons first patient who he has treated with this, he now thinks he has another. It is so rare that derms simply have not come across it before and therefore are not going to diagonose it, meaning not be able to treat it correctly. Push for a biopsy - this way you will know one way or another exactly what your bumps are and how to get rid of them. I have not had acne for the last 5 years so to have this new problem is so upsetting and i completely understand how you all feel.

I do not come on here a lot, but I really hope I have helped at least one person who may be in the same situation I was

And if any of you live in London - Dr Edward Seaton is the man to see. He is a genius.

Goodluck xxx

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Guest Timehealsall

thank you for such great insight. It is quite unfortunate that i do not live in LONDON, so i cannot go to your dermatologist.

I believe i have something very similar to this, please take a look at my photos (under timehealsall mega thread in the mild to moderate acne section), check out the last 12 or so pages and tell me if i have something similar to you.

I took tetracycline antibioitcs (doxycycline) for 6 months. I believe this may have worsened it (i had these lesions before to, my brother has them as well).

Please let me know a.s.a.p... and i hope you come back to this website.

Last but not least, did any of the lesions scar?

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I was just recently diagnosed with osteoma cutis, at age 64. I took tetracyclines in my 20's; accutane a little later in life. In my 40's, I had a dermatologist that removed what he thought was milia, one at a time for a period of months. But what he took out were hard, rock like substances, seemingly calcified. My face became somewhat smoother. However, in the last few years my face has gotten so much worse. I went back to a different dermatologist who actually took a punch biopsy and came back with this diagnosis. I don't believe I am a good candidate for removing these one at a time as my face is FILLED with hundreds of these. Basically, my dermatologist has said I will have to live with it as laser ablation wouldn't work. Is there anyone who has had any type of successful resolution with getting these things out of your face when there were so many to deal with?

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Hi there, FINALLY I am finding answers to what I have. I am actually a medical Aesthetician and I look at 1000's of faces under bright lights and have never seen what I have on anyone else. Not even close. I noticed almost 10 years ago a grayish bump under my skin that never went away. I have suffered with acne since the age of 9 with extremely oily skin. well after doing several lasers and being on retin A I have noticed more starting to surface. Being an Aesthetician I was determined to get them out! So with a needle and tweezers and many hours I was able to get a few out. These arent your typical black heads that just pop out. You actually have to dig them out, then even though they may seem to be almost out that's where I have to use tweezers and pull them out because they are attached with skin. once I get them out its like bone mass. about an off white color and not perfectly round they are very odd shaped. I still have about 13 of them saved in a jar that I have gotten out. Unfortunately I have many more left under the skin and some of made little scars from pulling them out. We even tried superficating them at work which helped only some of the time. Now I am trying to figure out a way to get them out without scarring. They are visible and you can feel them underneath my skin. I am putting on .1 retin A nightly which is making them surface but still almost impossible to get out. Looking for solutions.

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Hi guys, I’m in the same boat as all of you. I live in Los Angeles and it has taken me years to figure out that I have miliary osteomas from a biopsy. I’ve had some of them surgically removed. She will try to extract 5 and MAYBE 1 will come out. I went to a plastic surgeon even, and it was the same sad result. They don’t want to come out at all. I have a history of acne. I am very depressed by this. There is an article where a doctor in Texas uses erbium yag laser and he says he has good results but this looks terrifying to me. This is the article. https://jamanetwork.com/journals/jamadermatology/fullarticle/477772

He basically takes a lot of layers of skin off. I’m also half Mexican so I worry about pigmentation issues. Wondering about your guys thoughts? I wonder if there is a medication to stop the calcium growth? It seem so unfair. Retin a does help I feel, not taking them away, but potentially slowing down the growth of new ones. I also take spirniilactone 100mg and Bc pulls which keeps me from breaking out and that helps but I’m still getting new ones all the time. 

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