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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- 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