Calcinosis Cutis - Types, Causes, Symptoms, and Treatment

Introduction:

Calcinosis cutis is when calcium salts accumulate under the skin. It can occur due to several reasons like injury, infection, or kidney disease and presents differently in different patients. The calcium deposition occurs as hard bumps, which can vary in shape, size, and location and do not dissolve on their own. The condition has no symptoms; however, it can be very painful in some cases. Treatments like surgery are available, but the deposits tend to recur.

What Are the Types of Calcinosis Cutis?

Depending upon various factors, calcinosis cutis is classified into five types, which include:

1. Dystrophic.

2. Metastatic.

3. Idiopathic.

4. Iatrogenic.

5. Calciphylaxis.

What Are the Causes of Calcinosis Cutis?

The causes of various types of calcinosis cutis include:

Dystrophic Calcinosis Cutis:It is the most common type, which occurs due to injury or inflammation. Damaged tissue cells release phosphate proteins which further calcify, forming deposits. Tissue damage can occur due to infections, tumors, pimples (acne), or connective tissue disorders like lupus (an autoimmune disease causing inflammation in different body parts), dermatomyositis (an inflammatory condition having skin rash and muscle weakness), or systemic sclerosis (disorder in which fibrosis occurs in the skin and internal organs). Dystrophic calcifications do not have abnormal calcium and phosphorus levels in the body.

Metastatic Calcinosis Cutis: When the body has high calcium and phosphorus levels, it leads to the formation of calcium phosphate salts that get deposited as nodules under the skin. Abnormally high levels of calcium and phosphorus can occur in conditions such as

• Chronic kidney failure (which is the most common cause).

• Hyperparathyroidism (overactive parathyroid glands produce excess parathyroid hormone).

• Increased vitamin D.

• Milk-alkali syndrome (excess calcium intake from diet and antacids).

• Paget's disease (a condition in which bones grow larger and weaker).

• Sarcoidosis - A condition in which there is a tiny collection of inflammatory cells called granulomas, commonly involving the lymph nodes and lungs.

Idiopathic Calcinosis Cutis: There is neither tissue damage nor increased blood calcium and phosphorus levels, the cause is unknown. Idiopathic type is of three types, which include:

• Familial Tumoral Calcinosis - Calcium tumors occur around joints in children and healthy teens.

• Subepidermal Calcified Nodules - White bumps that occur on the eyes, skin, and scalp.

• Scrotal Calcinosis - Calcium deposits occur on the scrotum.

Iatrogenic Calcinosis Cutis: The condition occurs as a side effect of medical procedures, which causes calcium deposition. The procedures that can cause the condition include:

• Heel sticks are used for screening newborns for genetic diseases.

• Administering solutions that contain calcium and phosphates.

• Tuberculosis treatment involves IV (intravenous) administration of calcium chloride, calcium gluconate, and para-aminosalicylic acid.

• An extended contact time with calcium chloride electrode paste during ECG (electrocardiogram) or EEG (electroencephalogram).

• Organ transplantation.

Calciphylaxis: Calciphylaxis is an accumulation of calcium in the blood vessels and fatty tissues of the skin. The exact cause of occurrence is not clear; however, calciphylaxis can occur under the following conditions, which include:

• Obesity.

• Diabetes.

• Chronic or long-term kidney failure.

• Hyperparathyroidism.

What Are the Symptoms of Calcinosis Cutis?

The nodules of calcinosis cutis appear as hard, whitish-yellow colored bumps on the skin's surface. They usually appear slowly and may have no pain. However, the patient may complain of severe pain and a whitish substance oozing from the bumps in a few cases. In very rare cases, the condition becomes severe and life-threatening.

Based on the cause, the nodules can appear in different body parts. The most commonly involved body parts include

1. Fingers.

2. Forearm.

3. Elbow.

4. Face.

5. Eyelids.

6. Scalp.

7. Buttocks.

8. Joints.

9. Under the lupus sores. (systemic lupus erythematosus (SLE) is when the body's defense system destroys its cells, with symptoms like skin rash, erosion of joints, and kidney failure in rare cases).

The lumps can cause specific problems like

• Loss of movement.

• Difficulty walking or moving.

• Ulcers on the skin.

• Rigid muscles.

• Pain.

• Joint stiffness.

How Is Calcinosis Cutis Diagnosed?

Diagnosis of the type of calcinosis cutis is essential to provide appropriate treatment. Doctors do a physical examination and take down the history and symptoms of the patient. They may further advise laboratory tests to determine the underlying cause.

The following tests are advised, which include:

• Blood Tests: Blood tests help assess if the calcium and phosphate levels are high, check for lupus or suspected tumor markers, and rule out an imbalance in parathyroid hormone or vitamin D levels.

• Metabolic Tests: They include tests like kidney function tests that help rule out any kidney problems.

• Imaging Tests: Imaging tests like X-rays, CT (computerized tomography) scans, and bone scans help determine the extent of calcification.

• Biopsy: A small tissue sample is collected and sent to a laboratory to check for calcium deposits.

• Specialized Tests: These tests check for the possibility of diseases like dermatomyositis and milk-alkali syndrome.

• Advanced Vibrational Spectroscopy: A developing new technology that uses Fourier transform infrared (FT-IR) or Raman spectroscopic analysis which can rapidly analyze the chemical composition of the lumps and help assess the disease progression.

How Is Calcinosis Cutis Treated?

Treatment of calcinosis cutis depends on the cause. The various treatment options for calcinosis cutis include

Medications: Several drugs have been tried to treat the lumps; however, their success is limited. Medications used for treatment include:

• Corticosteroids.

• Colchicine.

• Probenecid.

• Diphosphonates.

• Diltiazem.

• Sodium etidronate.

• Magnesium and aluminum antacids.

• Warfarin.

• Ceftriaxone.

• Intravenous immunoglobulin (IVG).

• Minocycline.

• Topical sodium thiosulphate.

Surgery: Surgery is advised in cases where the lumps get painful, infected, or interfere with functioning. However, the lumps tend to recur after surgery; hence, starting the surgery with a small section of the skin is recommended.

Other Treatments: The other treatments for a few cases include hematopoietic stem cell transplantation (HSCT), laser therapy, and shock wave lithotripsy (a procedure that uses shock waves to break down kidney stones into smaller pieces to allow their exit through urine).

In a few cases, calcinosis cutis can also clear up without a need for treatment.

What Are the Risks of Treatment?

Calcinosis cutis may result in issues with

• Joints.

• Imperfections.

• Bruising.

• Infection.

• Pain and skin ulcers.

Some other complications are:

• Certain prescribed drugs may have adverse effects that worsen the condition or result in more significant health issues, such as renal problems.

• The skin may also be harmed or injured by laser or surgical removal. This may lead to the regrowth of the lesions. Infection and sluggish wound healing are additional hazards.

• It can be challenging to manage and treat calcineuriosis cutis because no single medication is effective for everyone. The use of individual strategies is required.

• Calcinosis cutis can occasionally result from connective tissue autoimmune disease treatment gone wrong. To reduce this risk, a doctor may advise early, vigorous therapy with immune-suppressive medications.

• See a doctor to rule out calcinosis cutis if there are lesions on the skin or around the joints.

Conclusion:

Calcinosis cutis is a medical condition in which calcium salts get deposited under the skin. There can be several reasons for it. Timely diagnosis and early treatment of severe symptoms are pivotal in reducing the risk of discomfort due to lumps and complications. Various doctors from different specialties have to work together as a team to achieve better results.