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Calcinosis Cutis


Presentation

  • Here, we present the case of a 67-year-old man with multiple sclerosis on chronic dexamethasone and concurrent supplementation of calcium and daily cholecalciferol presenting with painful calcified lesions.[ncbi.nlm.nih.gov]
  • This report aims to raise doctors' awareness of the presentation, course, and management of this relatively rare iatrogenic complication.[ncbi.nlm.nih.gov]
  • The condition presents as several brown to yellowish nodules on the scrotum, gradually progressive, and mostly asymptomatic.[ncbi.nlm.nih.gov]
  • Presented here is a case of bilateral pretibial calcinosis cutis in a patient on long-term tyrosine kinase inhibitor therapy for chronic myeloid leukemia.[ncbi.nlm.nih.gov]
  • A case of nevus lipomatosus cutaneous superficialis is presented, wherein the lesion occurred as a gluteal swelling in a 6-year-old boy.[ncbi.nlm.nih.gov]
Gangrene
  • […] calcification-cutaneous necrosis syndrome Clinical Features: Complication of renal failure, especially when there is secondary or tertiary hyperparathyroidism Painful violaceous lesions, most common on the trunk and extremities, which may progress to form ulcers and gangrene[dermpedia.org]
  • In very severe cases, the skin may become gangrenous at the affected site. Pictures Calcinosis cutis pictures from Dermatology Atlas Brazil courtesy of Samuel Freire da Silva, M.D.[healthhype.com]
  • In very severe cases, cutaneous gangrene has been seen to occur. Calcinosis cutis has four distinct subtypes, divided by conditions or events which present the underlying cause of the condition.[ozarkderm.com]
Noncompliance
  • On 6-month follow-up, this patient had only mild improvement after treatment with an anti-itch lotion and aluminum hydroxide, with which she was noncompliant.[ncbi.nlm.nih.gov]
Anorexia
  • She developed progressively increasing disk-like masses of calcinosis over the gluteal regions, knee, elbow, and ankle joints fixed to the overlying skin associated with malaise, anorexia, and weight loss.[ncbi.nlm.nih.gov]
Wound Infection
  • Eight complications were recorded in 6 patients, including weakness, decreased motion, numbness, and superficial wound infection.[ncbi.nlm.nih.gov]
Respiratory Distress
  • A 37-year-old white man diagnosed with multiple myeloma was admitted for respiratory distress.[ncbi.nlm.nih.gov]
Muscle Tenderness
  • There was no Raynaud's phenomenon, dysphagia, dyspnoea, sclerodermatous skin, sclerodactyly, telangectasias, or muscle tenderness/weakness.[ncbi.nlm.nih.gov]
Swelling of the Scrotum
  • Iatrogenic and traumatic calcinosis are those types which are associated with medical procedures. [1], [2] Case 1 30 year old male presented with multiple swelling in the scrotum of three months duration.[jlponline.org]

Workup

  • During the preop workup, careful clinical assessment had revealed multiple subcutaneous nodules affecting the extensor musculature limited to the gluteal region, anterior and posterior aspects of the thigh.[ncbi.nlm.nih.gov]
  • It can be of four types: dystrophic, metastatic, idiopathic, and iatrogenic. [1] Following clinical diagnosis of calcinosis cutis, a thorough laboratory workup must be carried out to detect the underlying cause.[amhsjournal.org]
  • A hormonal workup, including calcitonin, parathyroid hormone, and thyroid hormone levels, was also within normal limits.[karger.com]
  • As our patient has long-standing asymptomatic lesions and was only here due to ulceration of one, she refused additional workup for associated conditions and also refused excision of contralateral lesion.[amhsjournal.org]
Hyponatremia
  • He was found to have hypercalcemia (13.1 mg/dL), hyperphosphatemia (7.2 mg/dL), hyponatremia (121 mEq/L), and acute renal failure (serum urea nitrogen, 116 mg/dL; creatinine, 4.9 mg/dL).[ncbi.nlm.nih.gov]
  • Metabolic panel showed mild hyponatremia at 132 mmol/L, erythrocyte sedimentation rate of 120 mm/hour, C-reactive protein of 20.6 mg/L, hyperglycemia at 195 mg/dL, uremia, and decreased CO 2 .[woundsresearch.com]
  • […] treatment with prednisone, despite having received the intravenous hyperhydratation, diuretic therapy (intravenous furosemide) and anti-uricolytic therapy (oral allopurinol) from the beginning, she developed a severe tumor lysis syndrome (TLS) with hyponatremia[file.scirp.org]

Treatment

  • Therapy for calcinosis cutis consisted of medical treatment alone (n 19), surgical therapy alone (n 11), combined medical and surgical treatment (n 17), no treatment (n 30), and unknown (n 1).[ncbi.nlm.nih.gov]
  • Although great advances have been made in the treatment of juvenile dermatomyositis, little progress has been made in the treatment of calcinosis cutis.[ncbi.nlm.nih.gov]
  • Because calcinosis cutis is a rare syndrome, there is a notable lack of controlled clinical trials on its treatment. The efficacy of calcinosis treatment has only been reported in single cases or small case series.[ncbi.nlm.nih.gov]
  • Multiple treatments have been tried, with varying results; indeed, to date, no standard treatment has been generally accepted.[ncbi.nlm.nih.gov]
  • BACKGROUND: Dystrophic calcinosis cutis is a common manifestation in connective tissue diseases, but there's still no consensus on treatment.[ncbi.nlm.nih.gov]

Prognosis

  • These patients manifest without cutaneous involvement, but do not differ in its clinical or laboratory features and prognosis from classical systemic sclerosis.[ncbi.nlm.nih.gov]
  • Complications & Prognosis The prognosis of calcinosis cutis is generally good and calcium deposits typically improve gradually over time depending on correction of the underlying cause of disease.[animalallergycolorado.com]
  • This subtyping is closely related to the prognosis and response to treatment.[jlponline.org]
  • However, the prognosis is not usually as serious with calcinosis cutis. The condition can lead to severe disfigurement, superficial pain and skin ulcers. In rare instances, it can lead to gangrene due to blockage of blood flow.[healthhype.com]

Etiology

  • Due to its multifactorial pathogenesis, several subtypes and potential etiologies have been described.[ncbi.nlm.nih.gov]
  • These disorders can be separated based on etiology. Sodium thiosulfate has been used to systemically treat calciphylaxis with little to no adverse effects.[ncbi.nlm.nih.gov]
  • The pathogenesis of calcinosis cutis secondary to nadroparin injections remains controversial; Proposed causes included metastatic, dystrophic, iatrogenic, or multifactorial etiologies.[ncbi.nlm.nih.gov]
  • (See "Calcinosis cutis: Etiology and patient evaluation" and "Calciphylaxis (calcific uremic arteriolopathy)", section on 'Treatment' .)[uptodate.com]
  • It is classified into 4 major types according to etiology: dystrophic, metastatic, iatrogenic, and idiopathic.[ajnr.org]

Epidemiology

  • Epidemiology Calcinosis cutis commonly occurs in patients with systemic sclerosis, especially the limited form (CREST).[statpearls.com]
  • Clinical-epidemiological, cytological and histopathological study of idiopathic calcinosis cutis of the scrotum. J Clin Diagn Res. 2017;11(11):EC01–EC4. Google Scholar Jamaleddine FN, Salman SM, Shbaklo Z, Kibbi AG, Zaynoun S.[jmedicalcasereports.biomedcentral.com]
  • This article reviews the most updated literature regarding the epidemiology, pathophysiology, diagnosis, and treatment of calcinosis cutis in patients with systemic sclerosis (SSc). PubMed, Curr Opin Rheumatol, 2015 Nov;27(6):542–8.[sclero.org]
  • Further research examining the mechanisms of action of UVR in the pathogenesis of juvenile IIM is needed. [52, 53] Epidemiology In the United States, the annual incidence of JDM ranges from 2.5-4.1 cases per million population. [54] In the United Kingdom[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology remains unclear and no effective therapy is currently available. We report a 30-year-old woman with a 13-year history of SLE who developed multiple calcinosis cutis around both knees and we review the relevant published work.[ncbi.nlm.nih.gov]
  • This condition has an elusive pathophysiology and is often associated with autoimmune disorders, significantly impacting the disease burden. The clinical presentation of CC varies, and there is no gold standard treatment modality.[ncbi.nlm.nih.gov]
  • [Article in English, Portuguese] Author information 1 Dermatology at the Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil. anapaula.carocha@gmail.com Abstract Calcinosis cutis is an uncommon disease of unclear pathophysiology that is often[ncbi.nlm.nih.gov]
  • The pathophysiology of calcinosis cutis is not well understood, and there is a broad range of severity seen, from benign localized, small nodules to large, severely debilitating lesions (2).[clinicaltrials.gov]
  • Discussion Pathophysiology Various theories have been suggested regarding the elusive pathophysiology of CC. 1,4,7 Local alkaline phosphatase (ALP) elevations may lead to hydrolysis of extracellular pyrophosphates, which usually act to inhibit calcium[woundsresearch.com]

Prevention

  • There are currently no effective medical therapies for the prevention or treatment of calcinosis.[consano.org]
  • A total hip arthroplasty using the posterior approach was performed with minimal trauma to the calcified nodules and thereby preventing a source of persistent drainage and reducing morbidity due to infection. 2017 BMJ Publishing Group Ltd.[ncbi.nlm.nih.gov]
  • Your skin Holds body fluids in, preventing dehydration Keeps harmful microbes out, preventing infections Helps you feel things like heat, cold, and pain Keeps your body temperature even Makes vitamin D when the sun shines on it Anything that irritates[icdlist.com]
  • While various therapeutic modality have been used, no treatment has convincingly prevented or reduced calcinosis. We report two cases of calcinosis cutis combined with rheumatic disease.[synapse.koreamed.org]
  • Keep ulcerated areas clean and prevent pet from rubbing, scratching, licking or biting the irritated area. There is no specific treatment for calcinosis cutis, however, the underlying disease process must be addressed to help resolve this condition.[animalallergycolorado.com]

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