Calcinosis Cutis

Key Points
Formation of calcium deposits in the skin
Four subtypes with various causes
Symtoms of Calcinosis cutis vary with cause, but generally presents as lesions in various areas

Calcinosis cutis is the abnormal deposition of calcium in the skin. It usually consists of multiple lesions (rarely they may occur singly) which develop slowly and are often free of symptoms, appearing as firm, whitish-yellow papules, plaques or nodules on the skin. Over time, lesions may ulcerate and become tender, and affected persons may experience discharge of a whitish material consisting of varying forms of calcium. Lesions may be painful if located on the fingertips. Lesions which form on joints may limit mobility due to calcification of the skin and attendant stiffness. In very severe cases, cutaneous gangrene has been seen to occur.

Calcinosis cutis has four distinct subtypes, divided by conditions or events which present the underlying cause of the condition. Dystrophic Calcinosis cutis occurs where there is inflamed, damaged, neoplastic or necrotic conditions of the skin. Damage may be from various factors, and tissue tests within normal ranges for calcium and phosphate. Conditions which may cause dystrophic Calcinosis cutis include tissue trauma, Acne, varicose veins, infections, tumors, Connective tissue diseases (acquired and inherited), and Panniculitis. Metastatic Calcinosis cutis occurs when there is abnormal presence of calcium and phosphate in the skin, and can be caused by hyperparathyroidism, paraneoplastic hypercalcaemia, milk-alkali syndrome, excessive Vitamin D intake, Sarcoidosis, renal failure, or Calciphylaxis. Idiopathic Calcinosis cutis occurs in the absence of any known injury or contributing metabolic issue, and calcification is limited to one area. Iatrogenic Calcinosis cutis occurs in conjunction with treatments which include the administration of calcium or phosphate.

Differential Diagnosis (Other conditions with similar appearance)
Milia
Molluscum contagiosum
Mycetoma
Osteoma Cutis
Warts, Genital
Xanthomas

Diagnosis
Key Points
Diagnosis initially based on appearance of lesions
Lab tests will be performed to indicate which form of the condition is extant
Radiological tests may be performed to determine the extent of calcification
Skin Biopsy is performed to confirm diagnosis.

Diagnosis is initially based on the appearance of lesions, followed by lab testing to indicate which type of the condition the affected person has and radiological tests to find out how far the calcification has spread. Biopsies of affected areas are used to confirm diagnosis.

Treatment
Primary focus is treatment of the causal condition
Goal of treatment is to relieve symptoms, but is of limited benefit
Lesions are only removed if circumstances require, as trauma can make the condition worse

The best and most reliable treatment for Calcinosis cutis in all forms is to treat the causal condition. Other treatments to relieve symptoms are of limited benefit, and can in some cases make the condition worse. Medications which health care professionals may prescribe include corticosteroids, probenecid, colchicines, sodium etidronate, diphosphonates, diltiazem, and magnesium and aluminium antacids.

Health care professionals may recommend the removal of lesions if affected persons experience severe pain, lesions ulcerate and experience infection (recurrent), or cause functional impairment. Small portions of the lesions may be excised first to determine if surgery will worsen the disorder.