Calcinosis cutis#Traumatic calcinosis cutis

{{Short description|Medical condition in which calcium deposits form in the skin}}

{{Infobox medical condition (new)

| name = Calcinosis cutis

| synonyms =Cutaneous calcification

| image = Calcinosis cutis -- low mag.jpg

| caption = Micrograph of calcinosis cutis. The calcification is purple (bottom of image). H&E stain.

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Calcinosis cutis is an uncommon condition marked by calcium buildup in the skin and subcutaneous tissues. Calcinosis cutis can range in intensity from little nodules in one area of the body to huge, crippling lesions affecting a vast portion of the body.{{cite journal | last1=Gutierrez Jr | first1=Albert | last2=Wetter | first2=David A. | title=Calcinosis cutis in autoimmune connective tissue diseases: Calcinosis cutis and connective tissue disease | journal=Dermatologic Therapy | volume=25 | issue=2 | date=2012 | doi=10.1111/j.1529-8019.2012.01492.x | pages=195–206| doi-access=free | pmid=22741938 }} Five kinds of the condition are typically distinguished: calciphylaxis, idiopathic calcification, iatrogenic calcification, dystrophic calcification, and metastatic calcification.{{cite journal | last1=Reiter | first1=Nadine | last2=El-Shabrawi | first2=Laila | last3=Leinweber | first3=Bernd | last4=Berghold | first4=Andrea | last5=Aberer | first5=Elisabeth | title=Calcinosis cutis | journal=Journal of the American Academy of Dermatology | volume=65 | issue=1 | date=2011 | doi=10.1016/j.jaad.2010.08.038 | pages=1–12| pmid=21679810 }}

Tumors, inflammation, varicose veins, infections, connective tissue disease, hyperphosphatemia, and hypercalcemia can all lead to calcinosis. Systemic sclerosis is linked to calcineuris cutis.{{cite web | last1=Le | first1=Cuong | last2=Bedocs | first2=Paul M. | title=Calcinosis Cutis | publisher=StatPearls Publishing | date=2023-07-10 | pmid=28846311 |url=https://www.ncbi.nlm.nih.gov/books/NBK448127/ | access-date=2024-02-28}} Calcinosis is seen in Limited Cutaneous Systemic Sclerosis, also known as CREST syndrome (the "C" in CREST).{{Cite web |title=CREST syndrome: MedlinePlus Medical Encyclopedia Image |url=https://medlineplus.gov/ency/imagepages/19507.htm |access-date=2023-02-12 |website=medlineplus.gov |language=en}}

Signs and symptoms

Image:Calcinosis cutis new image.jpg

Lesions might be more severe and widespread, or they can develop gradually and show no symptoms. The nodules may cause pain and hinder function in addition to having a variety of sizes and shapes. The underlying condition determines the localization of the lesions in dystrophic calcification. The elbows, fingers, knees, and forearms are the most often affected regions in people with systemic sclerosis. Elbows, knees, and regions of prior inflammatory lesions in dermatomyositis are affected by calcification. Lupus erythematosus affects the limbs, buttocks, area beneath lupus lesions, and periarticular areas. Periarticular lesions are found in metastatic calcification. In tumoral calcinosis, the lesions are found around joints, but in idiopathic calcification, the lesions are found on children's faces as subepidermal calcified nodules. In iatrogenic calcification, the calcification is found at venipuncture sites.

Causes

Calcinosis may result from a variety of causes such as:

Calcinosis cutis is associated with systemic sclerosis.

Diagnosis

= Classification =

Calcinosis cutis may be divided into the following types:{{cite book |author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |display-authors=etal}}{{rp|527–530}}

== Dystrophic calcinosis cutis ==

Dystrophic calcinosis cutis is the most prevalent kind of calcification on the skin. The ectopic calcified mass usually consists of amorphous calcium phosphate and hydroxyapatite.{{cite journal | last=Wang | first=Wen-Jen | title=Calcinosis Cutis in Juvenile Dermatomyositis: Remarkable Response to Aluminum Hydroxide Therapy | journal=Archives of Dermatology | volume=124 | issue=11 | date=1988-11-01 | issn=0003-987X | doi=10.1001/archderm.1988.01670110077022 | page=1721| pmid=3178257 }} Dystrophic calcification is linked to a number of illnesses, such as infections, hereditary diseases, cutaneous neoplasms, and connective tissue diseases.{{cite journal | last1=Walsh | first1=John S | last2=Fairley | first2=Janet A | title=Calcifying disorders of the skin | journal=Journal of the American Academy of Dermatology | volume=33 | issue=5 | date=1995 | doi=10.1016/0190-9622(95)91803-5 | pages=693–706| pmid=7593766 }} The clinical manifestation can be as minor as an accidental radiography imaging finding or as severe as subcutaneous nodules or plaques.{{cite journal | last1=Boulman | first1=Nina | last2=Slobodin | first2=Gleb | last3=Rozenbaum | first3=Michael | last4=Rosner | first4=Itzhak | title=Calcinosis in Rheumatic Diseases | journal=Seminars in Arthritis and Rheumatism | publisher=Elsevier BV | volume=34 | issue=6 | year=2005 | issn=0049-0172 | doi=10.1016/j.semarthrit.2005.01.016 | pages=805–812| pmid=15942915 }}

== Metastatic calcinosis cutis ==

Metastatic calcinosis cutis is the consequence of calcium salts precipitating in normal tissue due to an underlying abnormality in the metabolism of phosphate and/or calcium. Metastatic calcification can result from any systemic condition raising serum calcium and/or phosphate levels. Chronic renal failure is the most frequent underlying cause.{{cite web | title=UpToDate | website=UpToDate |url=https://www.uptodate.com/contents/calcinosis-cutis-etiology-and-patient-evaluation | access-date=2024-02-29}}

== Iatrogenic calcinosis cutis ==

Iatrogenic calcinosis cutis is characterized by firm nodules in the subcutis or dermis, which are caused by calcium salts precipitating quickly in the skin. This occurrence typically manifests as a warm, sensitive swelling at the site of venipuncture, and it most frequently happens following the extravasation of intravenous calcium chloridecalcium gluconate, or phosphate-containing solutions.{{cite journal | last1=Amati | first1=C. | last2=Pesce | first2=V. | last3=Armenio | first3=A. | last4=Solarino | first4=G. | last5=Moretti | first5=B. | title=Tumoral calcinosis of the hand | journal=Journal of Surgical Case Reports | publisher=Oxford University Press (OUP) | volume=2015 | issue=4 | date=2015-04-08 | issn=2042-8812 | doi=10.1093/jscr/rjv036 | pages=rjv036| pmid=25858267 | pmc=4390718 | hdl=11586/171759 | hdl-access=free }} Iatrogenic calcification, which manifests as soft yellow-white epidermal plaques, has also been linked to calcium salt exposure via electroencephalography or electromyographic electrode compounds.{{cite journal | last1=Touart | first1=Diane M. | last2=Sau | first2=Purnima | title=Cutaneous deposition diseases. Part II | journal=Journal of the American Academy of Dermatology | publisher=Elsevier BV | volume=39 | issue=4 | year=1998 | issn=0190-9622 | doi=10.1016/s0190-9622(98)70001-5 | pages=527–546| pmid=9777759 }}

== Traumatic calcinosis cutis ==

Traumatic calcinosis cutis is a cutaneous condition characterized by calcification of the skin resulting from the deposition of calcium and phosphorus often resulting from occupational exposure, as in cases reported in oil-field workers and coal miners.{{cite book |author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |display-authors=etal}}{{rp|528}}

== Idiopathic calcinosis cutis ==

Skin calcification that is not linked to a systemic illness or an underlying tissue injury is referred to as idiopathic calcification. Most often, the calcification is restricted to a single general location, yet there has been one case of calcinosis cutis that is exceptionally broad.{{cite journal | last1=Guermazi | first1=Ali | last2=Grigoryan | first2=Mikayel | last3=Cordoliani | first3=Florence | last4=Kérob | first4=Delphine | title=Unusually diffuse idiopathic calcinosis cutis | journal=Clinical Rheumatology | volume=26 | issue=2 | date=2006-12-21 | issn=0770-3198 | doi=10.1007/s10067-005-0135-8 | pages=268–270| pmid=16416033 }}

== [[Idiopathic scrotal calcinosis]] ==

Idiopathic scrotal calcinosis is a cutaneous condition characterized by calcification of the skin resulting from the deposition of calcium and phosphorus occurring on the scrotum.{{cite book |author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |display-authors=etal}}{{rp|528}} However, the levels of calcium and phosphate in the blood are normal.{{cite journal|last=Grenader|first=Tal|author2=Shavit, Linda|title=Scrotal Calcinosis|journal=New England Journal of Medicine|date=Aug 18, 2011|volume=365|issue=7|pages=647|doi=10.1056/NEJMicm1013803|pmid=21848465}} Idiopathic scrotal calcinosis typically affects young males, with an onset between adolescence and early adulthood. The scrotal calcinosis appears, without any symptoms, as yellowish nodules that range in size from 1 mm to several centimeters.{{cite journal|vauthors=Khallouk A, Yazami OE, Mellas S, Tazi MF, El Fassi J, Farih MH|title=Idiopathic scrotal calcinosis: a non-elucidated pathogenesis and its surgical treatment.|journal=Reviews in Urology|date=2011|volume=13|issue=2|pages=95–7|pmid=21935341|pmc=3176555}}

== Subepidermal calcified nodule ==

Subepidermal calcified nodule is characterized by calcification of the skin resulting from the deposition of calcium and phosphorus, occurring most frequently as one or a few skin lesions on the scalp or face of children.{{cite book |author=James, William D. |author2=Berger, Timothy G.|title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |display-authors=etal}}{{rp|528}}

== [[Tumoral calcinosis]] ==

Tumoral calcinosis is distinguished by the accumulation of calcific masses surrounding the main joints. It mainly affects teens who are otherwise in good health. Joint function may be hampered by the subcutaneous or intramuscular calcified deposits.

== [[Osteoma cutis]] ==

Osteoma cutis is a cutaneous condition characterized by the presence of bone within the skin in the absence of a preexisting or associated lesion.{{cite book |author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |isbn=978-0-7216-2921-6 |display-authors=etal}}{{rp|529}} Osteoma cutis often manifests as solid, varying-sized, skin-colored subcutaneous nodules.{{cite journal | last1=Niebel | first1=Dennis | last2=Poortinga | first2=Sietske | last3=Wenzel | first3=rg | title=Osteoma Cutis and Calcinosis Cutis: "Similar but Different" | journal=The Journal of Clinical and Aesthetic Dermatology | publisher=Matrix Medical Communications | volume=13 | issue=11 | date=2020-09-22 | pages=28–31 | pmid=33282099 | pmc=7716738 }}

Treatment

Diltiazem, a calcium channel blocker, has been a mainstay of medical treatment for calcinosis cutis. It is thought to work by modifying intracellular calcium levels, which reduces the capacity for the production and crystallization of calcium nidus.{{cite journal | last1=Torralba | first1=Tito P. | last2=Li-Yu | first2=Julie | last3=Navarra | first3=Sandra T.G.V. | title=Successful Use of Diltiazem in Calcinosis Caused by Connective Tissue Disease | journal=JCR: Journal of Clinical Rheumatology | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=5 | issue=2 | year=1999 | issn=1076-1608 | doi=10.1097/00124743-199904000-00007 | pages=74–78| pmid=19078360 }}

Colchicine is an antimicrotubule drug with anti-inflammatory properties that has been used for gouty arthritis treatment for a long time. Calcinosis cutis inflammation brought on by a foreign body-like response aggravates the illness's symptoms.{{cite journal |last1=Fuchs |first1=D |last2=Fruchter |first2=L |last3=Fishel |first3=B |last4=Holtzman |first4=M |last5=Yaron |first5=M |title=Colchicine suppression of local inflammation due to calcinosis in dermatomyositis and progressive systemic sclerosis |journal=Clinical Rheumatology |date=December 1986 |volume=5 |issue=4 |pages=527–530 |pmid=3816102}} Colchicine, therefore, has been used to treat calcinosis cutis, albeit with varying degrees of success.

Gallery

Image:Calcinosis cutis dog.jpg|Calcinosis cutis in a dog with Cushing's syndrome

Image:Calcinosis cutis.jpg|Histopathology of calcinosis cutis in human tissue

See also

References

{{reflist}}

Further reading

  • {{cite journal | last1=Reiter | first1=Nadine | last2=El-Shabrawi | first2=Laila | last3=Leinweber | first3=Bernd | last4=Berghold | first4=Andrea | last5=Aberer | first5=Elisabeth | title=Calcinosis cutis | journal=Journal of the American Academy of Dermatology | volume=65 | issue=1 | date=2011 | doi=10.1016/j.jaad.2010.08.039 | pages=15–22 | pmid=21679811 | ref=none}}
  • {{cite journal | last1=Róbert | first1=Lili | last2=Kiss | first2=Norbert | last3=Medvecz | first3=Márta | last4=Kuroli | first4=Enikő | last5=Sárdy | first5=Miklós | last6=Hidvégi | first6=Bernadett | title=Epidemiology and treatment of calcinosis cutis: 13 years of experience | journal=Indian Journal of Dermatology | publisher=Medknow | volume=65 | issue=2 | year=2020 | pages=105–111 | issn=0019-5154 | doi=10.4103/ijd.ijd_527_18 | doi-access=free | pmid=32180595 | ref=none| pmc=7059479 }}