Calcinosis cutis

Signs and symptoms

Lesions may develop gradually without symptoms or become more severe and widespread. Nodules vary in size and shape, can cause pain, and may hinder function. In systemic sclerosis, the elbows, fingers, knees, and forearms are most often affected. Dermatomyositis involves the elbows, knees, and sites of prior inflammation.

Lupus erythematosus affects the limbs, buttocks, areas under lupus lesions, and periarticular regions. Metastatic calcification produces periarticular lesions. Idiopathic calcification appears on children's faces as subepidermal calcified nodules, while iatrogenic calcification occurs at venipuncture sites.

Diagnosis

Dystrophic calcinosis cutis is the most common type; the calcified mass consists of amorphous calcium phosphate and hydroxyapatite. It is linked to connective tissue diseases, infections, hereditary disorders, and cutaneous neoplasms. Clinical presentation ranges from an incidental radiographic finding to subcutaneous nodules or plaques. Metastatic calcinosis cutis results from calcium salt precipitation in normal tissue due to abnormal phosphate or calcium metabolism; chronic renal failure is the most frequent cause.

Iatrogenic calcinosis cutis presents as firm dermal or subcutaneous nodules, often a warm, tender swelling at venipuncture sites after extravasation of intravenous calcium chloride, calcium gluconate, or phosphate-containing solutions; it can also appear as soft yellow-white epidermal plaques from electrode compounds. Traumatic calcinosis cutis occurs from occupational exposure, as in oil-field workers and coal miners. Idiopathic calcification is not linked to systemic illness or tissue injury and is usually localized, though one exceptionally broad case exists.

Idiopathic scrotal calcinosis affects young males, appearing as asymptomatic yellowish nodules 1 mm to several centimeters on the scrotum with normal blood calcium and phosphate levels.

Treatment

Diltiazem, a calcium channel blocker, is a mainstay of medical treatment; it is thought to modify intracellular calcium levels, reducing the capacity for calcium nidus production and crystallization. Colchicine, an antimicrotubule drug with anti-inflammatory properties, has been used for calcinosis cutis inflammation caused by a foreign body-like response, though with varying success.