Calcinosis cutis is an uncommon condition marked by

calcium Calcium is a chemical element; it has symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar to it ...

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. Five kinds of the condition are typically distinguished: calciphylaxis, idiopathic calcification, iatrogenic calcification, dystrophic calcification, and metastatic calcification.

Tumors A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

varicose veins Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted. Although usually just a cosmetic ailment, in some cases they cause fatigue, pain, itch, itching, and cramp, nighttime leg cram ...

, infections, connective tissue disease, hyperphosphatemia, and

hypercalcemia Hypercalcemia, also spelled hypercalcaemia, is a high calcium (Ca2+) level in the blood serum. The normal range for total calcium is 2.1–2.6 mmol/L (8.8–10.7 mg/dL, 4.3–5.2 mEq/L), with levels greater than 2.6 mmol/L def ...

can all lead to calcinosis.

Systemic sclerosis Systemic scleroderma, or systemic sclerosis, is an autoimmune rheumatic disease characterised by excessive production and accumulation of collagen, called fibrosis, in the skin and internal organs and by injuries to small arteries. There are tw ...

is linked to calcineuris cutis. Calcinosis is seen in Limited Cutaneous Systemic Sclerosis, also known as

CREST syndrome CREST syndrome, also known as the limited cutaneous form of systemic sclerosis (lcSSc), is a multisystem connective tissue disease, connective tissue disorder. The acronym "CREST" refers to the five main features: calcinosis, Raynaud's phenomeno ...

(the "C" in CREST).

Signs and symptoms

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 Systemic scleroderma, or systemic sclerosis, is an autoimmune rheumatic disease characterised by excessive production and accumulation of collagen, called fibrosis, in the skin and internal organs and by injuries to small arteries. There are tw ...

. Elbows, knees, and regions of prior inflammatory lesions in

dermatomyositis Dermatomyositis (DM) is a Chronic condition, long-term inflammatory disorder, inflammatory Autoimmune disease, autoimmune disorder which affects the skin and the muscles. Its symptoms are generally a skin rash and worsening muscle weakness over ...

are affected by calcification.

Lupus erythematosus is a collection of autoimmune diseases in which the human immune system becomes hyperactive and attacks healthy tissues. Symptoms of these diseases can affect many different body systems, including joints, skin, kidneys, blood cells, heart, ...

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: * Trauma to the region * Inflammation (bug bites, acne) *

Varicose veins Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted. Although usually just a cosmetic ailment, in some cases they cause fatigue, pain, itch, itching, and cramp, nighttime leg cram ...

* Infections *

(malignant or benign) * Diseases of connective tissue *

Hypercalcemia Hypercalcemia, also spelled hypercalcaemia, is a high calcium (Ca2+) level in the blood serum. The normal range for total calcium is 2.1–2.6 mmol/L (8.8–10.7 mg/dL, 4.3–5.2 mEq/L), with levels greater than 2.6 mmol/L def ...

* Hyperphosphatemia Calcinosis cutis is associated with

Diagnosis

Classification

Calcinosis cutis may be divided into the following types:

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 Hydroxyapatite (International Mineralogical Association, IMA name: hydroxylapatite) (Hap, HAp, or HA) is a naturally occurring mineral form of calcium apatite with the Chemical formula, formula , often written to denote that the Crystal struc ...

. Dystrophic calcification is linked to a number of illnesses, such as infections, hereditary diseases, cutaneous neoplasms, and connective tissue diseases. The clinical manifestation can be as minor as an accidental radiography imaging finding or as severe as subcutaneous nodules or plaques.

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.

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 In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of venous Sampling (medicine)#blood, blood sampling (also called ''phlebotomy'') or intravenous therapy. In healthcare, this procedure is p ...

, and it most frequently happens following the extravasation of intravenous

calcium chloride Calcium chloride is an inorganic compound, a Salt (chemistry), salt with the chemical formula . It is a white crystalline solid at room temperature, and it is highly soluble in water. It can be created by neutralising hydrochloric acid with cal ...

, calcium gluconate, or

phosphate Phosphates are the naturally occurring form of the element phosphorus. In chemistry, a phosphate is an anion, salt, functional group or ester derived from a phosphoric acid. It most commonly means orthophosphate, a derivative of orthop ...

-containing solutions. Iatrogenic calcification, which manifests as soft yellow-white epidermal plaques, has also been linked to calcium salt exposure via

electroencephalography Electroencephalography (EEG) is a method to record an electrogram of the spontaneous electrical activity of the brain. The biosignal, bio signals detected by EEG have been shown to represent the postsynaptic potentials of pyramidal neurons in ...

or electromyographic electrode compounds.

Traumatic calcinosis cutis

Traumatic calcinosis cutis is a cutaneous condition characterized by calcification of the skin resulting from the deposition of

and

phosphorus Phosphorus is a chemical element; it has Chemical symbol, symbol P and atomic number 15. All elemental forms of phosphorus are highly Reactivity (chemistry), reactive and are therefore never found in nature. They can nevertheless be prepared ar ...

often resulting from occupational exposure, as in cases reported in oil-field workers and coal miners.

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.

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 In most terrestrial mammals, the scrotum (: scrotums or scrota; possibly from Latin ''scortum'', meaning "hide" or "skin") or scrotal sac is a part of the external male genitalia located at the base of the penis. It consists of a sac of skin ...

. However, the levels of calcium and phosphate in the blood are normal. 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.

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 lesion A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this ...

s on the

scalp The scalp is the area of the head where head hair grows. It is made up of skin, layers of connective and fibrous tissues, and the membrane of the skull. Anatomically, the scalp is part of the epicranium, a collection of structures covering th ...

or face of children.

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. Osteoma cutis often manifests as solid, varying-sized, skin-colored subcutaneous nodules.

Treatment

Diltiazem Diltiazem, sold under the brand name Cardizem among others, is a nondihydropyridine calcium channel blocker medication used to treat high blood pressure, angina, and certain heart arrhythmias. It may also be used in hyperthyroidism if beta b ...

, a

calcium channel blocker Calcium channel blockers (CCB), calcium channel antagonists or calcium antagonists are a group of medications that disrupt the movement of calcium () through calcium channels. Calcium channel blockers are used as antihypertensive drugs, i.e., as ...

, 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.

Colchicine Colchicine is a medication used to prevent and treat gout, to treat familial Mediterranean fever and Behçet's disease, and to reduce the risk of myocardial infarction. The American College of Rheumatology recommends colchicine, nonstero ...

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.

, 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 Histopathology (compound of three Greek words: 'tissue', 'suffering', and '' -logia'' 'study of') is the microscopic examination of tissue in order to study the manifestations of disease. Specifically, in clinical medicine, histopatholog ...

of calcinosis cutis in human tissue

References

External links

DermNet

WebMD
{{Electrolyte abnormalities Skin conditions resulting from errors in metabolism