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Calcinosis cutis: Management

Kristen H Fernandez, MD
Dana S Ward, MD
Section Editor
Jeffrey Callen, MD, FACP, FAAD
Deputy Editor
Abena O Ofori, MD


The term calcinosis cutis describes the deposition of insoluble calcium salts in the skin and subcutaneous tissue. There are five subtypes of calcinosis cutis: dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis.

The treatment of calcinosis cutis is often challenging and the subtype influences the approach to treatment. Potential interventions include treatment for an underlying disease, medication to reduce calcium deposits, medication to minimize inflammation, and physical removal of calcium deposits.

The management of the various subtypes of calcinosis cutis will be reviewed here. The diagnosis and evaluation of patients with calcinosis cutis is discussed separately. (See "Calcinosis cutis: Etiology and patient evaluation" and "Calciphylaxis (calcific uremic arteriolopathy)", section on 'Treatment'.)


Dystrophic calcinosis cutis, the most common form of calcinosis cutis, results from local tissue injury. Dystrophic calcinosis cutis most frequently occurs in association with autoimmune connective tissue diseases (particularly systemic sclerosis and dermatomyositis); therefore, the treatment of this presentation will be reviewed here. Less common causes include lobular panniculitides, porphyria cutanea tarda, select genodermatoses, cutaneous neoplasms, traumatic injury, and parasitic infections. (See "Calcinosis cutis: Etiology and patient evaluation", section on 'Dystrophic calcinosis cutis'.)

Treatment principles — The treatment of dystrophic calcinosis cutis associated with autoimmune connective tissue disease is often difficult. Therefore, the primary goal of treatment is to minimize symptoms and alleviate functional limitations rather than the complete resolution of cutaneous calcification [1].

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Literature review current through: Nov 2017. | This topic last updated: May 31, 2017.
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  1. 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.
  2. Boulman N, Slobodin G, Rozenbaum M, Rosner I. Calcinosis in rheumatic diseases. Semin Arthritis Rheum 2005; 34:805.
  3. Welborn MC, Gottschalk H, Bindra R. Juvenile Dermatomyositis: A Case of Calcinosis Cutis of the Elbow and Review of the Literature. J Pediatr Orthop 2015; 35:e43.
  4. Dima A, Balanescu P, Baicus C. Pharmacological treatment in calcinosis cutis associated with connective-tissue diseases. Rom J Intern Med 2014; 52:55.
  5. Vayssairat M, Hidouche D, Abdoucheli-Baudot N, Gaitz JP. Clinical significance of subcutaneous calcinosis in patients with systemic sclerosis. Does diltiazem induce its regression? Ann Rheum Dis 1998; 57:252.
  6. Ichiki Y, Akiyama T, Shimozawa N, et al. An extremely severe case of cutaneous calcinosis with juvenile dermatomyositis, and successful treatment with diltiazem. Br J Dermatol 2001; 144:894.
  7. Vinen CS, Patel S, Bruckner FE. Regression of calcinosis associated with adult dermatomyositis following diltiazem therapy. Rheumatology (Oxford) 2000; 39:333.
  8. Torralba TP, Li-Yu J, Navarra ST. Successful use of diltiazem in calcinosis caused by connective tissue disease. J Clin Rheumatol 1999; 5:74.
  9. Reiter N, El-Shabrawi L, Leinweber B, et al. Calcinosis cutis: part I. Diagnostic pathway. J Am Acad Dermatol 2011; 65:1.
  10. Dönmez O, Durmaz O. Calcinosis cutis universalis with pediatric systemic lupus erythematosus. Pediatr Nephrol 2010; 25:1375.
  11. Morgan KW, Callen JP. Calcifying lupus panniculitis in a patient with subacute cutaneous lupus erythematosus: response to diltiazem and chloroquine. J Rheumatol 2001; 28:2129.
  12. Goolamali SI, Gordon P, Salisbury J, Creamer D. Subcutaneous calcification presenting in a patient with mixed connective tissue disease and cutaneous polyarteritis nodosa. Clin Exp Dermatol 2009; 34:e141.
  13. Palmieri GM, Sebes JI, Aelion JA, et al. Treatment of calcinosis with diltiazem. Arthritis Rheum 1995; 38:1646.
  14. Robertson LP, Marshall RW, Hickling P. Treatment of cutaneous calcinosis in limited systemic sclerosis with minocycline. Ann Rheum Dis 2003; 62:267.
  15. Taborn J, Bole GG, Thompson GR. Colchicine suppression of local and systemic inflammation due to calcinosis universalis in chronic dermatomyositis. Ann Intern Med 1978; 89:648.
  16. Fuchs D, Fruchter L, Fishel B, et al. Colchicine suppression of local inflammation due to calcinosis in dermatomyositis and progressive systemic sclerosis. Clin Rheumatol 1986; 5:527.
  17. Bogoch ER, Gross DK. Surgery of the hand in patients with systemic sclerosis: outcomes and considerations. J Rheumatol 2005; 32:642.
  18. Mendelson BC, Linscheid RL, Dobyns JH, Muller SA. Surgical treatment of calcinosis cutis in the upper extremity. J Hand Surg Am 1977; 2:318.
  19. Lapner MA, Goetz TJ. High-speed burr debulking of digital calcinosis cutis in scleroderma patients. J Hand Surg Am 2014; 39:503.
  20. Wu JJ, Metz BJ. Calcinosis cutis of juvenile dermatomyositis treated with incision and drainage. Dermatol Surg 2008; 34:575.
  21. Chamberlain AJ, Walker NP. Successful palliation and significant remission of cutaneous calcinosis in CREST syndrome with carbon dioxide laser. Dermatol Surg 2003; 29:968.
  22. Cukierman T, Elinav E, Korem M, Chajek-Shaul T. Low dose warfarin treatment for calcinosis in patients with systemic sclerosis. Ann Rheum Dis 2004; 63:1341.
  23. Palaniappan P, Lionel AP, Kumar S. Successful treatment of calcinosis cutis in juvenile dermatomyositis with pamidronate. J Clin Rheumatol 2014; 20:454.
  24. Slimani S, Abdessemed A, Haddouche A, Ladjouze-Rezig A. Complete resolution of universal calcinosis in a patient with juvenile dermatomyositis using pamidronate. Joint Bone Spine 2010; 77:70.
  25. Mukamel M, Horev G, Mimouni M. New insight into calcinosis of juvenile dermatomyositis: a study of composition and treatment. J Pediatr 2001; 138:763.
  26. Terroso G, Bernardes M, Aleixo A, et al. Therapy of calcinosis universalis complicating adult dermatomyositis. Acta Reumatol Port 2013; 38:44.
  27. Schanz S, Ulmer A, Fierlbeck G. Response of dystrophic calcification to intravenous immunoglobulin. Arch Dermatol 2008; 144:585.
  28. Kalajian AH, Perryman JH, Callen JP. Intravenous immunoglobulin therapy for dystrophic calcinosis cutis: unreliable in our hands. Arch Dermatol 2009; 145:334; author reply 335.
  29. Smith GP. Intradermal sodium thiosulfate for exophytic calcinosis cutis of connective tissue disease. J Am Acad Dermatol 2013; 69:e146.
  30. Bair B, Fivenson D. A novel treatment for ulcerative calcinosis cutis. J Drugs Dermatol 2011; 10:1042.
  31. Wolf EK, Smidt AC, Laumann AE. Topical sodium thiosulfate therapy for leg ulcers with dystrophic calcification. Arch Dermatol 2008; 144:1560.
  32. Del Barrio-Díaz P, Moll-Manzur C, Álvarez-Veliz S, Vera-Kellet C. Topical sodium metabisulfite for the treatment of calcinosis cutis: a promising new therapy. Br J Dermatol 2016; 175:608.
  33. Hazen PG, Walker AE, Carney JF, Stewart JJ. Cutaneous calcinosis of scleroderma. Successful treatment with intralesional adrenal steroids. Arch Dermatol 1982; 118:366.
  34. Reiter N, El-Shabrawi L, Leinweber B, Aberer E. Subcutaneous morphea with dystrophic calcification with response to ceftriaxone treatment. J Am Acad Dermatol 2010; 63:e53.
  35. Eddy MC, Leelawattana R, McAlister WH, Whyte MP. Calcinosis universalis complicating juvenile dermatomyositis: resolution during probenecid therapy. J Clin Endocrinol Metab 1997; 82:3536.
  36. Riley P, McCann LJ, Maillard SM, et al. Effectiveness of infliximab in the treatment of refractory juvenile dermatomyositis with calcinosis. Rheumatology (Oxford) 2008; 47:877.
  37. Tan O, Atik B, Kizilkaya A, et al. Extensive skin calcifications in an infant with chronic renal failure: metastatic calcinosis cutis. Pediatr Dermatol 2006; 23:235.
  38. Sonohata M, Akiyama T, Fujita I, et al. Neonate with calcinosis cutis following extravasation of calcium gluconate. J Orthop Sci 2008; 13:269.
  39. Moss J, Syrengelas A, Antaya R, Lazova R. Calcinosis cutis: a complication of intravenous administration of calcium glucanate. J Cutan Pathol 2006; 33 Suppl 2:60.