Calcinosis Cutis Treatment & Management

  • Author: Julia R Nunley, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 7, 2011
 

Medical Care

Medical therapy of calcinosis cutis is limited and of variable benefit. When identified, the underlying problem should be corrected.

  • Intralesional corticosteroids may be beneficial because of their anti-inflammatory and inhibitory effects on fibroblast activity.
  • Probenecid and colchicine have been beneficial in some individuals.
  • Magnesium or aluminum antacids may be effective phosphate binders in patients with hyperphosphatemia. However, the use of these agents in patients with renal insufficiency may result in magnesium or aluminum toxicity.
  • Sodium etidronate and diphosphonates may reduce bone turnover and inhibit the growth of ectopic hydroxyapatite crystals. However, prolonged treatment is necessary, and paradoxical hyperphosphatemia may result.
  • Myo-inositol hexaphosphonate is a dietary substance shown to inhibit the crystallization of calcium salts. Recent animal studies have demonstrated a reduction in calcinosis cutis lesions with topical myo-inositol hexaphosphate. This potentially could be of benefit in humans.[18, 19]
  • Warfarin has shown benefit in some.
  • The use of the calcium-channel blocker diltiazem over at least 5 years has variable benefits. The therapeutic effect is believed to be the antagonism of the calcium-sodium ion pump.[20, 21]
  • Use of sodium thiosulfate may be considered as it has been shown to be effective in many cases of calciphylaxis. It would be considered off-label and experimental therapy.[22]
  • Minocycline may be another treatment option. Nine patients with cutaneous calcification associated with limited systemic sclerosis were treated with 50-100 mg/day of minocycline. Improvement was noted within 1-7 months in 8 of the patients. Although lesional size was only moderately improved, ulceration and inflammation were markedly reduced.[23]
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Surgical Care

Indications for surgical removal include pain, recurrent infection, ulceration, and functional impairment.

  • Because surgical trauma may stimulate calcification, initially treat a test site before pursuing a large excision.
  • Recurrence is common after excision.

Electric shock wave lithotripsy is anecdotally successful in dermatomyositis-induced tissue calcification.[24]

  • Although reduction in the size of the calcification was minimal, the patient's associated pain was completely relieved.
  • The physiology for this effect is unknown.
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Consultations

A nephrologist, a rheumatologist, and/or a hematologist should be consulted, as indicated by the underlying disease.

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Diet

Dietary alteration is of minor benefit in most cases.

The following changes may be tried:

  • Restrict dietary phosphorous when hyperphosphatemia is present.
  • Restrict dietary calcium intake when hypercalcemia is present.
  • A ketogenic diet that stresses the consumption of free fatty acids may be helpful in some individuals. An accumulation of ketoacids, the metabolic product of fatty acids, may lower tissue pH and prevent crystallization.
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Activity

Activity is affected only if the calcified plaques and/or nodules are large enough to restrict joint mobility or cause ischemia and/or ulceration.

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Contributor Information and Disclosures
Author

Julia R Nunley, MD  Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center

Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Lydia M E Jones, MD  Staff Physician, Department of Dermatology, Virginia Commonwealth University

Disclosure: Nothing to disclose.

Specialty Editor Board

James W Patterson, MD  Professor of Pathology and Dermatology, Director of Dermatopathology, University of Virginia Medical Center

James W Patterson, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Dermatopathology, Royal Society of Medicine, Society for Investigative Dermatology, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Rosalie Elenitsas, MD  Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology

Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Weinel S, Callen JP. Calcinosis cutis complicating adult-onset dermatomyositis. Arch Dermatol. Mar 2004;140(3):365-6. [Medline].

  2. Yun SJ, Lee JB, Kim SJ, Lee SC, Won YH, Kang HC. Calcinosis cutis universalis with joint contractures complicating juvenile dermatomyositis. Dermatology. 2006;212(4):401-3. [Medline].

  3. Marzano AV, Kolesnikova LV, Gasparini G, Alessi E. Dystrophic calcinosis cutis in subacute lupus. Dermatology. 1999;198(1):90-2. [Medline].

  4. Miteva L, Pramatarov K, Vassileva S. Calcinosis cutis in childhood systemic lupus erythematosus. J Eur Acad Dermatol Venereol. Sep 2003;17(5):611-2. [Medline].

  5. Rothe MJ, Grant-Kels JM, Rothfield NF. Extensive calcinosis cutis with systemic lupus erythematosus. Arch Dermatol. Aug 1990;126(8):1060-3. [Medline].

  6. Tristano AG, Villarroel JL, Rodriguez MA, Millan A. Calcinosis cutis universalis in a patient with systemic lupus erythematosus. Clin Rheumatol. Feb 2006;25(1):70-4. [Medline].

  7. Becuwe C, Roth B, Villedieu MH, Chouvet B, Kanitakis J, Claudy A. Milia-like idiopathic calcinosis cutis. Pediatr Dermatol. Jul-Aug 2004;21(4):483-5. [Medline].

  8. Eckman JA, Mutasim DF. Bullous systemic lupus erythematosus with milia and calcinosis. Cutis. Jul 2002;70(1):31-4. [Medline].

  9. Lee DW, Yoon DH, Lee YS, Shim SI, Cho BK. Solitary milialike idiopathic calcinosis cutis: a case unassociated with Down syndrome. J Dermatol. Jan 1996;23(1):53-5. [Medline].

  10. Sais G, Jucglà A, Moreno A, Peyrí J. Milia-like idiopathic calcinosis cutis and multiple connective tissue nevi in a patient with Down syndrome. J Am Acad Dermatol. Jan 1995;32(1):129-30. [Medline].

  11. Larralde M, Giachetti A, Kowalczuk A, D'Agostino D, Galimberti R. Calcinosis cutis following liver transplantation in a pediatric patient. Pediatr Dermatol. May-Jun 2003;20(3):225-8. [Medline].

  12. Lateo S, Charlton F, Hudson M, Lawrence CM. Cutaneous calcification following liver transplantation. Clin Exp Dermatol. Sep 2005;30(5):484-6. [Medline].

  13. Neau-Cransac M, Lepreux S, Labreze C, et al. Uncommon localization of calcinosis cutis after liver transplantation. Dermatology. 2005;211(4):379-81. [Medline].

  14. Aksoy HM, Ozdemir R, Karaaslan O, Tiftikcioglu YO, Oruc M, Kocer U. Incidental idiopathic calcinosis cutis in a rhytidectomy patient. Dermatol Surg. Aug 2004;30(8):1145-7. [Medline].

  15. Kannan S, Ravikumar L, Mahadevan S, et al. Tumoral calcinosis with vitamin D deficiency. Saudi J Kidney Dis Transpl. Nov 2008;19(6):960-3. [Medline].

  16. Bhattacharya A, Prasad V, Thomas EJ, Singh B, Mittal BR. Tc-99m MDP scintigraphy in a case of idiopathic calcinosis cutis. Clin Nucl Med. Jun 2005;30(6):431-2. [Medline].

  17. Larsen MJ, Adcock KA, Satterlee WG. Dermal uptake of technetium-99m MDP in calcinosis cutis. Clin Nucl Med. Nov 1985;10(11):780-2. [Medline].

  18. Grases F, Perello J, Isern B, Prieto RM. Study of a myo-inositol hexaphosphate-based cream to prevent dystrophic calcinosis cutis. Br J Dermatol. May 2005;152(5):1022-5. [Medline].

  19. Grases F, Perello J, Isern B, Prieto RM. Study of the absorption of myo-inositol hexakisphosphate (InsP6) through the skin. Biol Pharm Bull. Apr 2005;28(4):764-7. [Medline].

  20. Abdallah-Lotf M, Grasland A, Vinceneux P, Sigal-Grinberg M. Regression of cutis calcinosis with diltiazem in adult dermatomyositis. Eur J Dermatol. Mar-Apr 2005;15(2):102-4. [Medline].

  21. Palmieri GM, Sebes JI, Aelion JA, et al. Treatment of calcinosis with diltiazem. Arthritis Rheum. Nov 1995;38(11):1646-54. [Medline].

  22. Papadakis JT, Patrikarea A, Digenis GE, et al. Sodium thiosulfate in the treatment of tumoral calcifications in a hemodialysis patient without hyperparathyroidism. Nephron. 1996;72(2):308-12. [Medline].

  23. Robertson LP, Marshall RW, Hickling P. Treatment of cutaneous calcinosis in limited systemic sclerosis with minocycline. Ann Rheum Dis. Mar 2003;62(3):267-9. [Medline]. [Full Text].

  24. Chan AY, Li E. Electric shock wave lithotripsy (ESWL) as a pain control measure in dermatomyositis with calcinosis cutis-old method, new discovery. Clin Rheumatol. Apr 2005;24(2):172-3. [Medline].

  25. Campanelli A, Kaya G, Masouye I, Borradori L. Calcifying panniculitis following subcutaneous injections of nadroparin-calcium in a patient with osteomalacia. Br J Dermatol. Sep 2005;153(3):657-60. [Medline].

  26. De Beuckeleer LH, Vanhoenacker FM, Spinhoven M, Dieltjens A. Images in clinical radiology. Calcinosis cutis following calcium gluconate extravasation. JBR-BTR. Sep-Oct 2003;86(5):305. [Medline].

  27. Eich D, Scharffetter-Kochanek K, Weihrauch J, Krieg T, Hunzelmann N. Calcinosis of the cutis and subcutis: an unusual nonimmunologic adverse reaction to subcutaneous injections of low-molecular-weight calcium-containing heparins. J Am Acad Dermatol. Feb 2004;50(2):210-4. [Medline].

  28. Fitz-Henley M. Image and diagnosis. Cutaneous calcinosis (calcinosis cutis). West Indian Med J. Dec 2002;51(4):246, 272. [Medline].

  29. Giorgini S, Martinelli C, Massi D, Lumini A, Mannucci M, Giglioli L. Iatrogenic calcinosis cutis following nadroparin injection. Int J Dermatol. Oct 2005;44(10):855-7. [Medline].

  30. Ichikawa S, Imel EA, Sorenson AH, Severe R, Knudson P, Harris GJ, et al. Tumoral calcinosis presenting with eyelid calcifications due to novel missense mutations in the glycosyl transferase domain of the GALNT3 gene. J Clin Endocrinol Metab. Nov 2006;91(11):4472-5. Epub 2006 Aug 29. [Medline].

  31. Kacerovska D, Nemcova J, Pomahacova R, Michal M, Kazakov DV. Cutaneous and superficial soft tissue lesions associated with Albright hereditary osteodystrophy: clinicopathological and molecular genetic study of 4 cases, including a novel mutation of the GNAS gene. Am J Dermatopathol. Oct 2008;30(5):417-24. [Medline].

  32. Lai CH, Farah R, Mallory SB. Congenital calcinosis cutis of the ear. J Am Acad Dermatol. Jul 2003;49(1):122-4. [Medline].

  33. Mendoza LE, Lavery LA, Adam RC. Calcinosis cutis circumscripta. A literature review and case report. J Am Podiatr Med Assoc. Feb 1990;80(2):97-9. [Medline].

  34. Morgan MB. Nanobacteria and calcinosis cutis. J Cutan Pathol. Mar 2002;29(3):173-5. [Medline].

  35. Moss J, Syrengelas A, Antaya R, Lazova R. Calcinosis cutis: a complication of intravenous administration of calcium glucanate. J Cutan Pathol. Sep 2006;33 Suppl 2:60-2. [Medline].

  36. Ogretmen Z, Akay A, Bicakci C, Bicakci HC. Calcinosis cutis universalis. J Eur Acad Dermatol Venereol. Nov 2002;16(6):621-4. [Medline].

  37. Ozcelik B, Serin IS, Basbug M, Ozturk F. Idiopathic calcinosis cutis of the vulva in an elderly woman. A case report. J Reprod Med. Jul 2002;47(7):597-9. [Medline].

  38. Palamaras I, Kyriakis K. Calcium antagonists in dermatology: a review of the evidence and research-based studies. Dermatol Online J. 2005;11(2):8. [Medline].

  39. Plott T, Wiss K, Raimer SS, Solomon AR. Recurrent subepidermal calcified nodule of the nose. Pediatr Dermatol. May 1988;5(2):107-11. [Medline].

  40. Puvabanditsin S, Garrow E, Titapiwatanakun R, Getachew R, Patel JB. Severe calcinosis cutis in an infant. Pediatr Radiol. May 2005;35(5):539-42. [Medline].

  41. Rodriguez-Cano L, Garcia-Patos V, Creus M, Bastida P, Ortega JJ, Castells A. Childhood calcinosis cutis. Pediatr Dermatol. Mar-Apr 1996;13(2):114-7. [Medline].

  42. Sanchez-Merino JM, Bouso-Montero M, Fernandez-Flores A, Garcia-Alonso J. Idiopathic calcinosis cutis of the penis. J Am Acad Dermatol. Aug 2004;51(2 Suppl):S118-9. [Medline].

  43. Satter EK, Maari CH, Morel KD, et al. Disseminated linear calcinosis cutis associated with the Koebner phenomenon in an infant with congenital acute monocytic leukaemia. Br J Dermatol. Apr 2004;150(4):753-6. [Medline].

  44. Smack D, Norton SA, Fitzpatrick JE. Proposal for a pathogenesis-based classification of tumoral calcinosis. Int J Dermatol. Apr 1996;35(4):265-71. [Medline].

  45. Takahama H, Noto S, Ito M, Nishimoto H, Tadokoro M. A case of hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber's disease) with dystrophic calcinosis cutis and retinal lesions. J Dermatol. Aug 2002;29(8):512-5. [Medline].

  46. Tomizawa K, Tanaka S, Saito B, Ota K. A peculiar type of dystrophic calcinosis cutis affecting the surface of damaged genital skin and mucosa in an elderly woman with a vesicovaginal fistula. Br J Dermatol. Jan 2004;150(1):169-71. [Medline].

  47. Touart DM, Sau P. Cutaneous deposition diseases. Part II. J Am Acad Dermatol. Oct 1998;39(4 Pt 1):527-44; quiz 545-6. [Medline].

  48. Valdatta L, Buoro M, Thione A, et al. Idiopathic circumscripta calcinosis cutis of the knee. Dermatol Surg. Dec 2003;29(12):1222-4. [Medline].

  49. Viegas SF, Evans EB, Calhoun J, Goodwiller SE. Tumoral calcinosis: a case report and review of the literature. J Hand Surg [Am]. Sep 1985;10(5):744-8. [Medline].

  50. Walsh JS, Fairley JA. Calcifying disorders of the skin. J Am Acad Dermatol. Nov 1995;33(5 Pt 1):693-706; quiz 707-10. [Medline].

  51. Wozniak F, Maslankiewicz B. Idiopathic calcinosis cutis of the scrotum and penis. Ann Univ Mariae Curie Sklodowska [Med]. 1990;45:107-9. [Medline].

 
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Calcinosis cutis appearing as an indurated and nodular subcutaneous plaque in a patient with systemic lupus erythematosus.
Ulceration of a lesion of calcinosis cutis in a patient with systemic lupus erythematosus.
 
 
 
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