Calcinosis

Abstract

Calcinosis cutis is the deposition of calcium in the skin and subcutaneous tissues. It is associated with autoimmune connective tissue diseases (ACTDs) including systemic sclerosis (SSc). Calcinosis cutis may be classified into four categories: dystrophic calcification, which is the most common presentation of calcinosis associated with SSc, metastatic calcification, calciphylaxis, and idiopathic or iatrogenic. Calcinosis in SSc has been associated with longer disease duration, male gender, digital ulcers, acro-osteolysis, positive anti-centromere antibody (ACA), and positive anti-PM/Scl antibody. Calcinosis in SSc presents as subcutaneous nodules or lumps of variable size and shape, typically at sites of recurrent microtrauma. The most frequent body sites involved in SSc are the hands (particularly the fingers) and feet. Common complications of calcinosis are ulceration at the site of lesions, infection, pain, impaired function, and compression of nerves. If the clinical presentation does not allow a definite diagnosis, plain radiography may be helpful. More experimental diagnostic studies include ultrasonography (US), multidetector computed tomography (MDCT), and dual-energy computed tomography (DECT). Several pharmacologic therapies have been tried for calcinosis with variable results, including warfarin, bisphosphonates, diltiazem, ceftriaxone, colchicine, minocycline, probenecid, aluminum hydroxide, infliximab, rituximab, and intravenous immunoglobulin (IVIG). Surgical excision of calcium deposits remains the mainstay of treatment, but a combination of medical and surgical therapies may yield the best outcomes.