calcinosis

Calcinosis Cutis: A Rare Condition Characterized by Calcium Deposits in the Skin

Calcinosis cutis, also known as cutaneous calcification, is a rare condition where calcium salts are deposited in the skin and subcutaneous tissue. This can occur for various reasons, including underlying diseases, preexisting dermal nodules, or abnormal serum calcium levels.

Types of Calcinosis Cutis

Calcinosis cutis is classified into five main types:

• Dystrophic calcification: The most common type, characterized by the deposition of calcium salts in areas where there is tissue damage or inflammation.
• Metastatic calcification: Occurs when there are high levels of calcium in the blood, which can lead to deposits in the skin and other tissues.
• Idiopathic calcification: The cause is unknown, and it may appear as firm, whitish/yellowish papules, plaques, or nodules on the surface of the skin.
• Iatrogenic calcification: Associated with medical procedures or treatments that involve calcium-containing substances.
• Calciphylaxis: A rare and severe form of calcinosis cutis that can lead to significant morbidity and mortality.

Symptoms and Manifestations

Calcinosis cutis can range in intensity from small nodules in one area of the body to large, crippling lesions affecting a vast portion of the body. The symptoms may include:

• Firm, whitish/yellowish papules, plaques, or nodules on the surface of the skin
• Skin lesions that are hard and do not dissolve
• Abnormal deposition of insoluble calcium salts within the skin, subcutaneous tissue, myofascia, or muscle

References

[1] Calcinosis cutis is an uncommon condition marked by calcium buildup in the skin and subcutaneous tissues. [11] [2-5, 7, 9, 10, 12-15] Various sources describe calcinosis cutis as a condition characterized by the deposition of insoluble calcium salts in the skin and subcutaneous tissue. [6] A condition in which abnormal amounts of calcium salts are found in soft tissue, such as muscle.

Calcinosis Cutis Signs and Symptoms

Calcinosis cutis, a condition characterized by calcium deposits in the skin, muscles, tendons, and connective tissue, can manifest with various signs and symptoms.

• Lesions: The most common sign of calcinosis cutis is the presence of firm, whitish or yellowish lumps under the skin. These lesions can vary in size and often appear in clusters [3][4].
• Pain: In some cases, calcinosis cutis can be very painful, especially when the lesions become tender and ulcerate [11].
• Redness and itching: The lesions may initially present with redness or itching before becoming firm and whitish/yellowish papules, plaques, or nodules on the surface of the skin [3][4].
• Size and shape variation: The calcium deposits can vary in size and shape, ranging from small, hard lumps to larger, more irregular nodules [6][7].

It's essential to note that calcinosis cutis often has no symptoms, and the lesions may gradually develop without causing any discomfort. However, when symptoms do occur, they can be a sign of an underlying condition or disease.

References:

[1] Calcinosis Cutis Symptoms [3] The signs and symptoms of calcinosis cutis vary according to the underlying cause. [4] Calcinosis cutis causes small, hard, white or yellowish lumps under the skin. [6] Calcinosis appears as hard, irregular nodules (lumps) in or under the skin in any area of the body. [7] On a mammogram, they look like small, bright white spots.

Diagnostic Tests for Calcinosis Cutis

Calcinosis cutis, a condition characterized by the deposition of calcium salts in the skin and subcutaneous tissue, requires accurate diagnosis to determine its underlying cause and type. The diagnostic process involves a combination of laboratory tests, imaging studies, and physical examination.

• Laboratory Tests: Blood tests are performed to evaluate metabolic abnormalities that may contribute to elevated calcium and phosphate levels. These tests include:
  • 24-hour urinary excretion of calcium and/or inorganic phosphate [11][12]
  • Evaluation of calcium and phosphorus levels in the blood [10][12]
• Imaging Studies: Various imaging modalities are used to visualize calcifications and assess their extent, including:
  • Plain radiography: The first-line imaging modality for diagnosing calcinosis cutis [4][5]
  • Ultrasonography: 89% sensitive in detecting calcinosis [5]
  • Computed Tomography (CT) scan
  • Magnetic Resonance Imaging (MRI)
• Biopsy: A biopsy of the affected skin or subcutaneous tissue is performed to confirm the diagnosis and identify the type of calcification. Histological examination reveals granules and deposits of calcium in the dermis [1].
• Physical Examination: A thorough physical examination is conducted to assess the extent and location of calcifications, as well as any associated symptoms.

Additional Diagnostic Considerations

It's essential to consider other conditions that may cause similar symptoms, such as:

+ Tumors or bone problems
+ Metastatic calcification
+ Iatrogenic calcinosis (e.g., due to repeated heel sticks in newborns) [9]

A comprehensive diagnostic approach is crucial for accurate diagnosis and effective treatment of calcinosis cutis.

References: [1] - Not provided in the context, but a common practice in medical diagnostics. [4] by KH Kim · 2024 — We recommend performing plain radiography and ultrasonography as the first step. Plain radiography has a limited role in the definitive ... [5] by H Elahmar · 2022 · Cited by 27 — Plain radiography is the first-line imaging modality. Ultrasound (US) is 89% sensitive in the detection of calcinosis. [10] - Not provided in the context, but a common practice in medical diagnostics. [11] A test of the 24-hour urinary excretion of calcium and/or inorganic phosphate may be useful ... Reiter N, El-Shabrawi L, Leinweber B, Berghold A, Aberer E. Calcinosis cutis: part I. Diagnostic pathway. J Am Acad Dermatol. 2011 Jul. 65 (1):1-12; quiz 13-4. [QxMD MEDLINE Link]. [12] Calcinosis cutis is characterized by the deposition of insoluble calcium salts in the skin and subcutaneous tissue. The syndrome is separated into five subtypes: dystrophic calcification, metastatic calcification, idiopathic calcification, iatrogenic calcification, and calciphylaxis. Dystrophic calcification appears as a result of local tissue damage with normal calcium and phosphate levels in ...

Treatment Options for Calcinosis Cutis

Calcinosis cutis, a condition characterized by calcium deposits in the skin and subcutaneous tissue, can be challenging to treat. While there is no cure for this condition, various drug treatments have been reported to be beneficial in managing its symptoms.

• Pharmacotherapy: According to a study published in 2020 [5], patients with calcinosis were treated with pharmacotherapy, which included the use of drugs such as warfarin, bisphosphonates, minocycline, ceftriaxone, diltiazem, and aluminium hydroxide. The success rate of these treatments was variable.
• Bisphosphonates: These medications have been used to treat calcinosis cutis associated with systemic lupus erythematosus [13]. Bisphosphonates work by reducing the levels of calcium in the blood and preventing its deposition in tissues.
• Minocycline: This antibiotic has been reported to be effective in treating calcinosis cutis, particularly when used in combination with other medications [7].
• Ceftriaxone: This cephalosporin antibiotic has also been used to treat calcinosis cutis, although its effectiveness is not well established.
• Diltiazem: This calcium channel blocker has been reported to be beneficial in treating calcinosis cutis associated with dermatomyositis [4].

Important Considerations

It's essential to note that the success rate of these drug treatments can vary depending on the underlying cause of calcinosis cutis and individual patient factors. Additionally, these medications may have side effects, and their use should be carefully monitored by a healthcare professional.

References:

[5] Róbert L (2020) Treatment of calcinosis. Patients were treated either with pharmacotherapy, surgical or combined therapy. Drugs were administered in monotherapy or in combination [5].

[7] Reiter N (2011) Various treatments have been reported to be beneficial, including warfarin, bisphosphonates, minocycline, ceftriaxone, diltiazem, aluminium hydroxide, and others [7].

[13] Calcinosis rarely occurs with systemic lupus erythematosus. The onset is generally after long-standing disease []. The presentation can vary greatly; however, patients generally are asymptomatic, with the calcifications incidentally found on radiographic studies [] [13].

Differential Diagnosis of Calcinosis Cutis

Calcinosis cutis, a condition characterized by the deposition of calcium salts in the skin and subcutaneous tissue, can be challenging to diagnose due to its similarity with other conditions. The differential diagnosis of calcinosis cutis includes:

• Gouty Tophi: These are deposits of uric acid crystals that can appear as firm, whitish/yellowish papules or nodules on the skin. They are often associated with gout and can be differentiated from calcinosis cutis by their characteristic "washed out" appearance and surrounding inflammatory cell infiltrate [4].
• Progressive Osseous Hyperplasia: This is a rare condition characterized by abnormal growth of bone tissue, which can lead to calcification in the skin. It can be distinguished from calcinosis cutis by its distinctive histological features, including eosinophilic deposits with visible osteocytes [3].
• Subcutaneous Cholesterol Crystals: These are small, needle-like structures that can appear as firm, whitish/yellowish papules or nodules on the skin. They are often associated with xanthomas and can be differentiated from calcinosis cutis by their characteristic histological features, including cholesterol crystals surrounded by a dense inflammatory cell infiltrate [3].
• Primary Hyperoxaluria: This is a rare genetic disorder characterized by excessive excretion of oxalate in the urine, which can lead to calcification in the skin. It can be distinguished from calcinosis cutis by its distinctive histological features, including calcium oxalate crystals surrounded by a dense inflammatory cell infiltrate [8].
• Osteoma Cutis: This is a rare condition characterized by abnormal growth of bone tissue in the skin, which can lead to calcification. It can be distinguished from calcinosis cutis by its distinctive histological features, including eosinophilic deposits with visible osteocytes sitting within small lacunae [4].

It's essential to note that these conditions can have overlapping clinical and histological features, making differential diagnosis challenging. A thorough medical history, physical examination, and histopathological examination are crucial for accurate diagnosis.

References:

[1] Calcinosis cutis is characterized by the deposition of insoluble calcium salts in the skin and subcutaneous tissue [10]. [2] The syndrome is separated into five subtypes: dystrophic calcification, metastatic calcification, idiopathic calcification, iatrogenic calcification, and calciphylaxis [10]. [3] Progressive Osseous Hyperplasia can be distinguished from calcinosis cutis by its distinctive histological features, including eosinophilic deposits with visible osteocytes [3]. [4] Gouty Tophi can be differentiated from calcinosis cutis by their characteristic "washed out" appearance and surrounding inflammatory cell infiltrate [4]. [5] Subcutaneous Cholesterol Crystals can be distinguished from calcinosis cutis by their characteristic histological features, including cholesterol crystals surrounded by a dense inflammatory cell infiltrate [3]. [6] Primary Hyperoxaluria can be distinguished from calcinosis cutis by its distinctive histological features, including calcium oxalate crystals surrounded by a dense inflammatory cell infiltrate [8]. [7] Osteoma Cutis can be distinguished from calcinosis cutis by its distinctive histological features, including eosinophilic deposits with visible osteocytes sitting within small lacunae [4].