Calcinosis cutis: Etiology and patient evaluation
- Kristen H Fernandez, MD
Kristen H Fernandez, MD
- Assistant Professor
- University of Missouri, Columbia
- Dana S Ward, MD
Dana S Ward, MD
- Associate Professor Emerita of Dermatology
- University of Missouri
Calcinosis cutis is a descriptive term for the deposition of insoluble calcium salts in the cutaneous and subcutaneous tissue. Based upon the etiology of calcium deposition, there are five subtypes of calcinosis cutis: dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis (table 1).
●Dystrophic calcinosis cutis: Dystrophic calcinosis cutis results from local tissue damage. Systemic calcium metabolism is normal.
●Metastatic calcinosis cutis: Metastatic calcinosis cutis results from abnormal calcium or phosphate metabolism, leading to the precipitation of calcium in skin and subcutaneous tissue.
●Idiopathic calcinosis cutis: Idiopathic calcinosis cutis is the occurrence of calcinosis cutis without any underlying tissue damage or metabolic disorder.
●Iatrogenic calcinosis cutis: Iatrogenic calcinosis cutis is the deposition of calcium salts in the skin as a side effect of medical intervention for other disease processes.
- Reiter N, El-Shabrawi L, Leinweber B, et al. Calcinosis cutis: part I. Diagnostic pathway. J Am Acad Dermatol 2011; 65:1.
- Boulman N, Slobodin G, Rozenbaum M, Rosner I. Calcinosis in rheumatic diseases. Semin Arthritis Rheum 2005; 34:805.
- Touart DM, Sau P. Cutaneous deposition diseases. Part II. J Am Acad Dermatol 1998; 39:527.
- Balin SJ, Wetter DA, Andersen LK, Davis MD. Calcinosis cutis occurring in association with autoimmune connective tissue disease: the Mayo Clinic experience with 78 patients, 1996-2009. Arch Dermatol 2012; 148:455.
- Walsh JS, Fairley JA. Calcifying disorders of the skin. J Am Acad Dermatol 1995; 33:693.
- Robertson LP, Marshall RW, Hickling P. Treatment of cutaneous calcinosis in limited systemic sclerosis with minocycline. Ann Rheum Dis 2003; 62:267.
- Velayos EE, Masi AT, Stevens MB, Shulman LE. The 'CREST' syndrome. Comparison with systemic sclerosis (scleroderma). Arch Intern Med 1979; 139:1240.
- Valenzuela A, Chung L, Casciola-Rosen L, Fiorentino D. Identification of clinical features and autoantibodies associated with calcinosis in dermatomyositis. JAMA Dermatol 2014; 150:724.
- Meher BK, Mishra P, Sivaraj P, Padhan P. Severe calcinosis cutis with cutaneous ulceration in juvenile dermatomyositis. Indian Pediatr 2014; 51:925.
- Eastham AB, Velez NF, Chesebro AL, et al. Diffuse dystrophic calcinosis cutis of the scalp in a patient with scalp discoid lupus erythematosus and systemic lupus erythematosus. JAMA Dermatol 2013; 149:246.
- Rey J, Hesse S, Bonerandi JJ. Extensive calcifications of the scalp in a patient with porphyria cutanea tarda secondary to hepatitis C virus infection. J Eur Acad Dermatol Venereol 2007; 21:286.
- Grossman ME, Bickers DR, Poh-Fitzpatrick MB, et al. Porphyria cutanea tarda. Clinical features and laboratory findings in 40 patients. Am J Med 1979; 67:277.
- Federico A, Weinel S, Fabre V, Callen JP. Dystrophic calcinosis cutis in pseudoxanthoma elasticum. J Am Acad Dermatol 2008; 58:707.
- Fernandez KH, Liu V, Swick BL. Nonuremic calciphylaxis associated with histologic changes of pseudoxanthoma elasticum. Am J Dermatopathol 2013; 35:106.
- Murata K, Nakashima H. Werner's syndrome: twenty-four cases with a review of the Japanese medical literature. J Am Geriatr Soc 1982; 30:303.
- Honjo S, Yokote K, Fujimoto M, et al. Clinical outcome and mechanism of soft tissue calcification in Werner syndrome. Rejuvenation Res 2008; 11:809.
- Villan S, Sever A, Mills P, et al. Unusual breast calcification due to Ehlers-Danlos syndrome, detected by mammography. Clin Radiol 2005; 60:1216.
- Lupi O. Protozoa and worms. In: Dermatology, 2nd ed, Bolognia JL, Jorizzo JL, Rapini RP, et al. (Eds), Elsevier Mosby, St. Louis 2008. Vol 2, p.1263.
- Levine MA. An update on the clinical and molecular characteristics of pseudohypoparathyroidism. Curr Opin Endocrinol Diabetes Obes 2012; 19:443.
- Bernardo BD, Huettner PC, Merritt DF, Ratts VS. Idiopathic calcinosis cutis presenting as labial lesions in children: report of two cases with literature review. J Pediatr Adolesc Gynecol 1999; 12:157.
- Holliday AC, Clos A, Kelly B. Firm papules on the penis and scrotum. Dermatol Online J 2014; 20.
- Nico MM, Bergonse FN. Subepidermal calcified nodule: report of two cases and review of the literature. Pediatr Dermatol 2001; 18:227.
- Kantor GR, Olivo MP. Subepidermal calcified nodule in an octogenarian. Arch Dermatol 1989; 125:1438.
- Leung YY, Lai R. Tumoral calcinosis: a case report. J Orthop Surg (Hong Kong) 2011; 19:108.
- Amati C, Pesce V, Armenio A, et al. Tumoral calcinosis of the hand. J Surg Case Rep 2015; 2015.
- Fairley JA. Calcifying and ossifying disorders of the skin. In: Dermatology, 2nd ed, Bolognia JL, Jorizzo JL, Rapini RP, et al. (Eds), Elsevier Mosby, St. Louis 2008. Vol 1, p.653.
- Ehsani AH, Abedini R, Ghiasi M, Hoseini MS. Calcinosis cutis complicating liver transplantation. Dermatol Online J 2006; 12:23.
- Shmidt E, Murthy NS, Knudsen JM, et al. Net-like pattern of calcification on plain soft-tissue radiographs in patients with calciphylaxis. J Am Acad Dermatol 2012; 67:1296.
- Kim HS, Kim MJ, Lee JY, et al. Multiple subepidermal calcified nodules on the thigh mimicking molluscum contagiosum. Pediatr Dermatol 2011; 28:191.
- Dystrophic calcinosis cutis
- - Associated disorders
- Autoimmune connective tissue disease
- Porphyria cutanea tarda
- Cutaneous neoplasms
- Metastatic calcinosis cutis
- - Associated disorders
- Chronic renal failure
- Other disorders
- Idiopathic calcinosis cutis
- - Associated disorders
- Idiopathic calcification of the scrotum
- Subepidermal calcified nodule
- Tumoral calcinosis
- Iatrogenic calcinosis cutis
- DIFFERENTIAL DIAGNOSIS
- PATIENT EVALUATION
- Patient history
- Physical examination
- Radiologic studies
- Laboratory studies
- SUMMARY AND RECOMMENDATIONS