Purpose

To report a rare case of bilateral lower eyelid calcinosis cutis clinically masquerading as xanthelasma in an otherwise healthy young patient and to increase awareness regarding uncommon periocular lesion differentials.

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Methods

A 25-year-old Saudi male with no significant medical history presented with longstanding bilateral medial lower eyelid lesions near the medial canthi. The lesions had remained stable for approximately 15 years and were asymptomatic. Clinical examination demonstrated yellowish plaques measuring 8.0 × 4.0 mm on the right lower eyelid and 3.0 × 1.5 mm on the left, raising suspicion for xanthelasma. Laboratory investigations were unremarkable. Bilateral lesion excision was performed.

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Results

Postoperative recovery was uneventful with satisfactory wound healing. Histopathological analysis unexpectedly demonstrated calcinosis cutis characterized by multiple dermal calcium deposits with overlying hyperplastic epidermis, without evidence of xanthelasma. No recurrence or functional complications were observed during two years of follow-up.

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Conclusion

Periocular calcinosis cutis is exceptionally uncommon and is more frequently associated with systemic or metabolic disorders. Reported periocular cases predominantly involve the upper eyelids. Bilateral isolated lower eyelid involvement in a healthy young patient represents an extremely rare presentation. This case highlights the importance of histopathological confirmation in atypical periocular lesions, broadens the differential diagnosis of lesions clinically resembling xanthelasma, and aims to improve clinician awareness of rare periocular lesion mimickers.

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Additional Authors

First name	Last name	Base Hospital / Institution
Basheer	Aldajani	Imam Abdulrahman bin Faisal University (IAU), Dammam, Saudi Arabia.

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