Calcinosis cutis



Calcinosis cutis


Rajani Nalluri and Ian Coulson


Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports


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Calcinosis cutis is a rare disease of aberrant calcium deposition in the skin and subcutaneous tissue. There are four major types:



Other rare variants of calcinosis cutis that have been described include calcinosis cutis circumscripta, calcinosis universalis, tumoral calcinosis, transplant-associated calcinosis cutis, and milia-like idiopathic calcinosis cutis (usually associated with Down syndrome). Firm white or yellow dermal lesions may ulcerate and extrude a gritty material. Stiffening of the skin can limit joint mobility and function, and fingertip lesions may be painful.



Management strategy


The first step in management is to identify any underlying cause. Dystrophic calcification occurs in up to 10% of patients with scleroderma and 10–40% of patients with juvenile dermatomyositis, but is rare in systemic lupus erythematosus. Examination and investigations for connective tissue disease are therefore strongly recommended. Skin biopsy can help to distinguish cutaneous calcification from ossification.


A number of malignancies have been implicated in causing metastatic calcification (e.g., leukemia and multiple myeloma). However, successful treatment of the underlying cause does not always have an impact on calcinosis cutis, which frequently requires other treatment modalities. There are no large studies for the treatment of calcinosis cutis, and most therapies are based on case reports.


Spontaneous extrusion of calcium salts may occur; this may need surgical encouragement. Intralesional corticosteroids, aluminum hydroxide supplements, bisphosphonates, diltiazem, colchicine, and probenecid have shown success, mostly in calcinosis associated with dermatomyositis. Low-dose minocycline has been reported to reduce the frequency of ulceration and inflammation associated with cutaneous calcinosis in patients with limited systemic sclerosis. The mechanism of action may be mainly through inhibition of matrix metalloproteinases and anti-inflammatory effects.


Warfarin has been advocated in both dermatomyositis and systemic sclerosis-associated calcinosis for small calcified deposits. Carbon-dioxide laser vaporization, extracorporeal shock wave lithotripsy and intravenous immunoglobulin are recent approaches that have been tried in cutaneous calcinosis secondary to CREST syndrome.




First-line therapies


















image No treatment/self-healing E
image Aluminum hydroxide D
image Intralesional corticosteroid E
image Diltiazem C







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Aug 7, 2016 | Posted by in Dermatology | Comments Off on Calcinosis cutis

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