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sally

My stubborn whiteheads and milia are not what I thought they were

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I've had these stubborn deep hard bumps under my skin for years, almost 2 decades now. They looked like acne and were mildly pigmented so my skin never looked clear even when I had no active acne for years. No dermatologist has been able to tell me what they were till now. I've had laser and cautery for some of them, but it wasnt enough. When it was superficially done it did nothing to flatten the bumps, only created wounds on top of them. When the doctor went in deep (created an open, wet wound) a few days later, I was able to see a few hardened grains embedded in the wound. They were still impossible to squeeze out, I had to either use a needle to pry them out or a forcep to extract. They looked like grains of sand/ hardened rice, impossible to crush with fingers. 

Thereafter there would be ugly craters that took several months to heal (in terms of color and depth), but in the end it looked better than before extraction. Before extraction they looked like active acne, and were brown and discolored. After complete healing, there are small residual scars that are not discolored and so barely noticeable. 

I still have several of them on my left cheek. They hardly respond to AHAs, bhas, retinoids etc, which I have used for years. Anyway the formal diagnosis for them is OSTEOMA CUTIS. Finally i saw a very experienced dermatologist who told me what they were and when I went home to google, I saw he was right. Mystery solved after 17 years!!

It is a rare (but I suspect not so rare) complication of acne, and is basically made up of bone. 

If if any of you suspect you have this, surgical extraction is probably the only route. The final result is good but recovery is very long for me because of the depth of these lesions. Anyone else who has experience with this, please share. 

 

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It is such a frustrating diagnosis and condition.  If you have any success with  removals would you please share? I had one doctor that was great at removals fresh out of medical school and then he became very successful and told me he didn't have time to do these as it literally would take about an hour to take out 6-8.  I tried  laser removal with less than skilled hands and that's been tough to heal. Take care. 

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reviving this thread..i have also been diagnosed with osteoma cutis..i have gone to 2 doctors.. Dr Seaton in London recommended by a user here he was lovely but said the only real effective treatment is excision. I wanted a second opinion due to permanent scarring and went to another derm who was confident we could get them out by electrocautery..we tested on 2 bumps ( i probably have about 7 in total but i hate them!!) as soon as the crust came off the bumps were completely flat YAY BUT only to my disappointment a few days later the bumps started to form again :(((( i have a follow up with this derm next week i just dont know what the next course of action will be? ive read a few case studies the YAG erbium laser has been successful solution? i'm afraid  im just delaying the inevitable which to truly remove these bumps is excision..

I too suspect this came about as a result of taking roaccutane after a major chin breakout..a very hasty decision that has cost me the last 18months with these bumps that have strabgely appeared on my cheeks where i didnt have any acne..

anyway would be great if anyone has had better results from this condition please share 

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Sorry to hear as it’s such a  frustrating disorder with no clear treatment.   I too tried electrocautery therapy which doesn’t work.  There is no way to get rid of other than removing such as Dr. Seaton said.   I would be very cautious about lasers because the whole reason they start in the first place is typically inflammation which creates an environment for them to form and a laser will do just that.  The very best thing to do to prevent new bumps is be kind to your skin and keep it calm.  I was prescribed niacinimide to take orally and sometimes if my skin is okay with it use a topical form.  Good luck and please share if any docs have encouraging treatment. 

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HI ejny thanks so much for the reply !so i saw the derm yesterday that did electrocautery for a follow up and he basically didnt have any answers..I suggested Erbium Yag laser since i read a few case studies reporting success but he was reluctant and said it is the same thing as electrocautery ie. burning of the skin so if electrocautery didnt work than laser wont work either. He pretty much told me to go back to Dr Seaton to get them out LOL  

Are you in the UK? I posted something on another site and a plastic surgeon in the US said that laser will only treat the skin not the bone so really need something to dig them out. Im realising some kind of surgical intervention is going to be required whether that is in combination with a laser or not. A user on here JOY999 had gone to Dr Seaton and had about 70 removed and she sweared she had no scarring! I inboxed her but no response..fair enough it was in 2011. I hope it is because she is so happy with her face  shes never had to come back on here..Interesting you said about inflammation because i notice that sometimes the bumps feel more firm after work when i come home than first thing in the morning they feel "softer".  I have read some cases where Tretinion 0.05% cream worked to decrease or eliminate but it is a slow process. Whatever I choose to do i need to let my skin completely heal from the electrocautery first which sucks cause it didnt even work :(

 

Edited by Athina1999
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Hi, I have seen on line where a laser was effective but they treated a very small area and then extracted the matter which is a bone fragment with another tool.  I’ve had laser treatment and it didn’t work for me as the doctors were not skilled at all. It took so long to heal just heartbreaking. I live in New York but would love to be able to see Dr. Seaton as he sounds like he’s quite proficient as in my case it takes a long time to take these out.  Typically I’ve had max 8 removed at once. I just had removals done four weeks ago and went to Florida last week a bit too soon as I am still healing.  The tretinion is another double edge sword as you want to keep the skin calm and sometimes it irritate. it doesn’t diminish them but some dermatologist feels it brings them to the surface faster for removal others think it helps regulate cell renewal and healthy skin so they don’t form in the first place.  I use sparingly as I have very sensitive skin and rosacea.

Best of luck with whatever you do! I know we concentrate on these bumps so much but people always tell me they don’t see them.  If I have any success with treatment I’ll reach out. 

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Thanks so much ejny  I wish you all the best too!!! its nice to know i am not the only one going through this although i wish this upon noone! thats the worst thing is that other people cant see but they dont know what its like to feel hard bumps on your face! 

Can I ask you when you got them removed did it leave any scarring? i am terrified of replacing a bump with a scar :(

Dr Seaton said there would be minimal scarring that will heal well over the time but I guess everyones expectations is different of what is cosmetically acceptable or not. I think i will make another appointment to see him. Perhaps can ask if he knows any doctors in NY who have treated this condition for you as well.

 

Edited by Athina1999
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Hi, 

see the osteoma in the middle of my forehead? They are mainly on my cheeks. Anyway I do scar a bit as I am olive skinned.  It’s the only way they go away sadly but good post removal care makes all the difference as in no sun and follow doctors orders.  Goofy pic and in makeup but you will heal.  

Best!

 

 

7FC18865-59DA-48CD-96CE-58C13BE3A6AA.jpeg

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wow thanks so much! i honestly cant see anything on your face you look great! but i understand its more how they feel than anything.. it doesnt look like you have any scars at all :) i am of mediterranean descent so olive skinned also, little lighter than you,i do find a scar easily..

And have you found that they don't come back in the same areas that they were surgically removed? 

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 That picture is deceiving because there are a lot of bumps on my cheeks they just photograph OK if there is a flash on the camera.   I do scar from the removals dealing with a bunch right now and trying to keep them out of the sun when I go south. Again it’s just a very frustrating disorder but you are near one of the best for removals. Good luck and be kind to your skin. 

 To answer your question they do  not seem to come back in the spot they were removed from. 

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On 7/13/2016 at 11:33 PM, sally said:

I've had these stubborn deep hard bumps under my skin for years, almost 2 decades now. They looked like acne and were mildly pigmented so my skin never looked clear even when I had no active acne for years. No dermatologist has been able to tell me what they were till now. I've had laser and cautery for some of them, but it wasnt enough. When it was superficially done it did nothing to flatten the bumps, only created wounds on top of them. When the doctor went in deep (created an open, wet wound) a few days later, I was able to see a few hardened grains embedded in the wound. They were still impossible to squeeze out, I had to either use a needle to pry them out or a forcep to extract. They looked like grains of sand/ hardened rice, impossible to crush with fingers. 

...Anyway the formal diagnosis for them is OSTEOMA CUTIS. Finally i saw a very experienced dermatologist who told me what they were and when I went home to google, I saw he was right. Mystery solved after 17 years!!

...
If if any of you suspect you have this, surgical extraction is probably the only route. The final result is good but recovery is very long for me because of the depth of these lesions. Anyone else who has experience with this, please share. 

 

 

I am not a dermatologist and it maybe the mentioned diagnosis is correct, but I was struck by this sentence: They looked like grains of sand/ hardened rice, impossible to crush with fingers. 

This is very similar to what I experienced and no dermatologist was ever sure what they were. I now think they are keratin plugs (keratin is very hard), I wrote a post about it.

 

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HI @Salinas thank you for your reply and read your post! glad to hear you have found a solution for your condition!

With osteoma cutis these cannot be extracted (my old dermatologist thought mine were milia too and tried to extract them with no success) nor will any laser or electrocautery work as it is bone formation of the skin so almost impossible to treat :-\ i would try anything at this point though 

 

 

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14 hours ago, Athina1999 said:

HI @Salinas thank you for your reply and read your post! glad to hear you have found a solution for your condition!

With osteoma cutis these cannot be extracted (my old dermatologist thought mine were milia too and tried to extract them with no success) nor will any laser or electrocautery work as it is bone formation of the skin so almost impossible to treat :-\ i would try anything at this point though 

 

I can't extract mine too, in my experience pieces of keratin are stuck in my skin and only with brute force creating a wound I could get them out. In my humble opinion milia and keratosis pilaris are just labels, the key thing is those grains in my skin or whatever you can call them are made of hard keratin. I have been so several dermatologists in the past, they all said something different, none mentioned keratin :smileys_n_people_23:

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21 hours ago, Athina1999 said:

and you found using urea cream has helped flatten them out? 

I think I've decided to get mine cut out out :(  

 

Yes. Urea in high concentration of 20% or more and salicyclic acid are the two proven chemical substances that can break down keratin. A cream that contains both worked best for me.

goodluck

 

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something to think about:

Keratosis pilaris can affect 50–80% of teenagers and up to 40% of adults.

https://www.skinsight.com/skin-conditions/adult/keratosis-pilaris

and kerotosis pilaris is nothing else than keratin clogging a pore and can be deep under the skin too, not just close to the surface like in those photos.

Looking at those numbers, I would not be surprised that what many think is acne / clogged pores, is actually keratin and urea is the best solution for this, but in my experience rarely mentioned.

Edited by Salinas
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