Calcinosis Cutis Clinical Presentation

Updated: Mar 05, 2020
  • Author: Julia R Nunley, MD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

Most lesions of calcinosis cutis develop gradually and are asymptomatic. However, the history and evolution of the lesions depend on the etiology of the calcification. Patients with dystrophic calcification may provide a history of an underlying disease, a preexisting dermal nodule (which represents a tumor), or an inciting traumatic event. Patients with metastatic calcification most frequently have a history of chronic renal failure. Cases of idiopathic calcinosis cutis usually are not associated with previous trauma or disease. Those who develop iatrogenic calcinosis cutis generally have a history of recent hospitalization.

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Physical Examination

The clinical presentation of calcinosis cutis can vary according to the diagnosis and underlying process. In general, multiple, firm, whitish dermal papules, plaques, nodules, or subcutaneous nodules are found in a distribution characteristic for the specific disorder. At times, these lesions may be studded with a yellow-white, gritty substance. Not infrequently, the lesions spontaneously ulcerate, extruding a chalky, white material. Most lesions are asymptomatic, though some may be tender, and others may restrict joint mobility. When severe, vascular calcification can cause diminished pulses and cutaneous gangrene.

Note the images below.

Calcinosis cutis appearing as an indurated and nod 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 pa Ulceration of a lesion of calcinosis cutis in a patient with systemic lupus erythematosus.

Note the following types and manifestations:

  • Dystrophic calcinosis cutis: Calcification is usually localized to a specific area of tissue damage, though it may be generalized in some disorders.

  • Metastatic calcinosis cutis: Calcium deposition frequently is widespread. Large deposits are frequently found around large joints, such as knees, elbows, and shoulders, in a symmetrical distribution. Visceral organ deposition of calcium in the lung, kidneys, blood vessels, and stomach actually occurs more frequently than deposition within the skin or muscle.

  • Idiopathic calcinosis cutis: Calcification most commonly is localized to one general area.

  • Iatrogenic calcinosis cutis: Calcification generally is located at the site of an invasive procedure, though diffuse deposition may occur.

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Complications

Complications of calcinosis cutis include pain, cosmetic disfigurement, ulceration, and mechanical compromise.

The plaques or nodules may impinge on adjacent structures such as joints, resulting in restricted mobility, and nerves, resulting in pain or paresthesia. Destruction of synovial tissue also may result. Vascular occlusion may result in gangrene. Ulceration may be complicated by bacterial infection.

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