Calcinosis cutis: Part I. Diagnostic pathway

Journal of the American Academy of Dermatology

Volumn 65, Issue 1, 2011, Pages 1-12

  Reiter, Nadine ^a   El Shabrawi, Laila ^a   Leinweber, Bernd ^a   Berghold, Andrea ^a   Aberer, Elisabeth ^a  

^a MEDICAL UNIVERSITY OF GRAZ   (Austria)

Author keywords

calcinosis cutis; diagnosis; review; skin calcification

Indexed keywords

CALCIUM; PHOSPHATE;

CALCINOSIS; CALCIUM BLOOD LEVEL; DERMATOMYOSITIS; EHLERS DANLOS SYNDROME; HISTOPATHOLOGY; HUMAN; IATROGENIC CALCIFICATION; IDIOPATHIC CALCIFICATION; LUPUS ERYTHEMATOSUS; LUPUS PANNICULITIS; METASTATIC CALCIFICATION; PANCREATIC PANNICULITIS; PHOSPHATE BLOOD LEVEL; PILOMATRIXOMA; PORPHYRIA CUTANEA TARDA; PRIORITY JOURNAL; PSEUDOXANTHOMA ELASTICUM; REVIEW; SCLERODERMA; SEBACEOUS CYST; SKIN CALCIFICATION; SKIN INJURY; SUBEPIDERMAL CALCIFIED NODULE; TUMOR CALCINOSIS; WERNER SYNDROME;

BIOPSY, NEEDLE; CALCINOSIS; CALCIPHYLAXIS; CALCIUM; CONNECTIVE TISSUE DISEASES; DISEASE PROGRESSION; EDUCATION, MEDICAL, CONTINUING; FEMALE; FOLLOW-UP STUDIES; HUMANS; IMMUNOHISTOCHEMISTRY; MALE; RISK FACTORS; SKIN DISEASES;

EID: 79958856106     PISSN: 01909622     EISSN: 10976787     Source Type: Journal    
DOI: 10.1016/j.jaad.2010.08.038     Document Type: Review

References (83)

1. Walsh JS, Fairley JA. Calcifying disorders of the skin. J Am Acad Dermatol 1995;33:693-706.
2. Wang WJ, Lo WL, Wong CK. Calcinosis cutis in juvenile dermatomyositis: remarkable response to aluminum hydroxide therapy. Arch Dermatol 1988;124:1721-2.
3. Kim SY, Choi HY, Myung KB, Choi YW. The expression of molecular mediators in the idiopathic cutaneous calcification and ossification. J Cutan Pathol 2008;35:826-31.
4. Touart DM, Sau P. Cutaneous deposition diseases. Part II. J Am Acad Dermatol 1998;39:527-46.
5. Eisen AZ, Tu JH. Scleroderma. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, editors. Fitzpatrick's dermatology in general medicine. New York: McGraw-Hill; 2005. p. 2023-33.
6. Shetty S, Moore TL, Jackson S, Brettle D, Herrick AL. A pilot study of acetic acid iontophoresis and ultrasound in the treatment of systemic sclerosis-related calcinosis. Rheumatology 2005;44:536-8. (Pubitemid 41511147)
7. Robertson LP, Marshall RW, Hickling P. Treatment of cutaneous calcinosis in limited systemic sclerosis with minocycline. Ann Rheum Dis 2003;62:267-9. (Pubitemid 36238096)
8. Davies CA, Jeziorska M, Freemont AJ, Herrick AL. Expression of osteonectin and matrix Gla protein in scleroderma patients with and without calcinosis. Rheumatology 2006;45:1349-55. (Pubitemid 44605468)
9. Silver RM. Clinical aspects of systemic sclerosis (scleroderma). Ann Rheum Dis 1991;50:854-61.
10. Rabens SF, Bauer M. Minimal scleroderma with extensive calcinosis cutis. Calif Med 1973;118:69-71.
11. Buchowski JM, Ahn NU, Ahn UM, McCarthy EF, Mehta MB. Disproportionately severe calcinosis cutis in an 88-year-old patient with CREST syndrome. Skeletal Radiol 2001;30:478-81. (Pubitemid 32750382)
12. Hazen PG, Askari A. Localized scleroderma with cutaneous calcinosis. A distinctive variant. Arch Dermatol 1979;115:871-2.
13. Jinnin M, Ihn H, Asano Y, Yamane K, Yazawa N, Tamaki K. A case of linear scleroderma with muscle calcification. Br J Dermatol 2002;146:1084-6. (Pubitemid 34779496)
14. Flores-Alvarado DE, Esquivel-Valerio JA, Garza-Elizondo M, Espinoza LR. Linear scleroderma en coup de sabre and brain calcification: is there a pathogenic relationship? J Rheumatol 2003;30:193-5.
15. Sallum A, Pivato F, Doria-Filho U, Aikawa N. Risk factors associated with calcinosis of juvenile dermatomyositis. J Pediatr 2008;84:68-74. (Pubitemid 351287725)
16. Kovacs SO, Kovacs SC. Dermatomyositis. J Am Acad Dermatol 1998;39:899-922.
17. Eddy MC, Leelawattana R, McAlister WH, Whyte MP. Calcinosis universalis complicating juvenile dermatomyositis: resolution during probenecid therapy. J Clin Endocrinol Metab 1997;82: 3536-42. (Pubitemid 27509333)
18. Ichiki Y, Akiyama T, Shimozawa N, Suzuki Y, Kondo N, Kitajima Y. An extremely severe case of cutaneous calcinosis with juvenile dermatomyositis, and successful treatment with diltiazem. Br J Dermatol 2001;144:894-7. (Pubitemid 32374801)
19. Fisler RE, Liang MG, Fuhlbrigge RC, Yalcindag A, Sundel RP. Aggressive management of juvenile dermatomyositis results in improved outcome and decreased incidence of calcinosis. J Am Acad Dermatol 2002;47:505-11.
20. Weinel S, Callen JP. Calcinosis cutis complicating adult-onset dermatomyositis. Arch Dermatol 2004;140:365-6. (Pubitemid 38332495)
21. Mukamel M, Horev G, Mimouni M. New insight into calcinosis of juvenile dermatomyositis: a study of composition and treatment. J Pediatr 2001;138:763-6. (Pubitemid 32417684)
22. Park YM, Lee SJ, Kang H, Cho SH. Large subcutaneous calcification in systemic lupus erythematosus: treatment with oral aluminum hydroxide administration followed by surgical excision. J Korean Med Sci 1999;14: 589-2.
23. Rothe MJ, Grant-Kels JM, Rothfield NF. Extensive calcinosis cutis with systemic lupus erythematosus. Arch Dermatol 1990; 126:1060-3. (Pubitemid 20233180)
24. Tristano A, Villarroel J, Rodríguez M, Millan A. Calcinosis cutis universalis in a patient with systemic lupus erythematosus. Clin Rheumatol 2006;25:70-4.
25. Okada J, Nomura M, Shirataka M, Kondo H. Prevalence of soft tissue calcifications in patients with SLE and effects of alfacarcidol [abstract]. Lupus 1999;8:456-61. (Pubitemid 29423580)
26. 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; 21:286-7. (Pubitemid 46128730)
27. Krajnc I, Rozman B, Pahor A. Porphyria cutanea tarda with severe clinical complications. A 20-year follow-up [in German]. Hautarzt 1998;49:571-5.
28. Thomas CL, Badminton MN, Rendall JRS, Anstey AV. Sclerodermatous changes of face, neck and scalp associated with familial porphyria cutanea tarda. Clin Exp Dermatol 2008;33: 422-4. (Pubitemid 351832116)
29. Grossman ME, Bickers DR, Poh-Fitzpatrick MB, Deleo VA, Harber LC. Porphyria cutanea tarda. Clinical features and laboratory findings in 40 patients [abstract]. Am J Med 1979; 67:277-86. (Pubitemid 9239524)
30. Buka R, Wei H, Sapadin A, Mauch J, Lebwohl M, Rudikoff D. Pseudoxanthoma elasticum and calcinosis cutis. J Am Acad Dermatol 2000;43:312-5. (Pubitemid 30626013)
31. Federico A, Weinel S, Fabre V, Callen JP. Dystrophic calcinosis cutis in pseudoxanthoma elasticum. J Am Acad Dermatol 2008;58:707-10. (Pubitemid 351375043)
32. Hendig D, Schulz V, Arndt M, Szliska C, Kleesiek K, Gotting C. Role of serum fetuin-A, a major inhibitor of systemic calcification, in pseudoxanthoma elasticum. Clin Chem 2006;52:227-34. (Pubitemid 43185483)
33. Leone A, Costantini AM, Brigida R, Antoniol OM, Antonelli- Incalzi R, Bonomo L. Soft-tissue mineralization in Werner syndrome. Skeletal Radiol 2005;34:47-51. (Pubitemid 40089754)
34. Özturk M, Akdeniz N, Ayakta H, Kösem M. A brother and sister with Werner's syndrome demonstrating extensive tendon calcification and sacroiliitis. Clin Exp Dermatol 2006;31:615-6. (Pubitemid 43806616)
35. Villan S, Sever A, Mills P, Mounter NA, Sever AR. Unusual breast calcification due to Ehlers - Danlos syndrome, detected by mammography. Clin Radiol 2005;60:1216-8. (Pubitemid 41511616)
36. Radhakrishnan L, Salman WD, Howat AJ. Breast calcifications in EhlerseDanlos syndrome. The Breast Journal 2008;14:196-7.
37. Proske S, Hartschuh W, Enk A, Hausser I. EhlerseDanlos syndrome - 20 years experience with diagnosis and classification at the university skin clinic of Heidelberg [in German]. J Dtsch Dermatol Ges 2006;4:308-18. (Pubitemid 44139131)
38. Beighton P, Horan F. Orthopaedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg Br 1969;51:444-53.
39. Rook A, Wilkinson DS, Ebling FJG. Disorders of collagen Ehlers- Danlos syndrome. In: Champion RH, editor. Textbook of dermatology, vol. 3. Boston, MA: Blackwell Scientific; 1998. p. 2033.
40. Braun-Falco O, editor. Dermatology. Fith completely revised edition. Berlin Heidelberg: Springer; 2005. p. 1165.
41. Yamamoto O, Hamada T, Doi Y, Sasaguri Y, Hashimoto H. Immunohistochemical and ultrastructural observations of desmoplastic trichoepithelioma with a special reference to a morphological comparison with normal apocrine acrosyringeum. J Cutan Pathol 2002;29:15-26. (Pubitemid 34155164)
42. Requena L, Yus ES. Panniculitis. Part II. Mostly lobular panniculitis. J Am Acad Dermatol 2001;45:325-61.
43. Chen M, Chen K, Chen M, Lee N, Tsai C, Yang R, et al. Lupus profundus (panniculitis) in a chronic haemodialysis patient. Nephrol Dial Transplant 1999;14:966-8. (Pubitemid 29155159)
44. Schmitt J, Bode B, Dumont C. Free functional gracilis muscle transfer for reconstruction of massive ectopic calcification following a lower extremity fracture: a case report and overview of the literature. Arch Orthop Trauma Surg 2007;127:61-6. (Pubitemid 44964038)
45. Lee HW, Jeong YI, Suh HS, Lee MW, Choi JH, Moon KC, et al. Two cases of dystrophic calcinosis cutis in burn scars. J Dermatol 2005;32:282-5. (Pubitemid 40745763)
46. Rho NK, Youn SJ, Park HS, Kim WS, Lee ES. Calcified nodule on the heel of a child following a single heel stick in the neonatal period. Clin Exp Dermatol 2003;28:502-3.
47. Strumía R, Lombardi AR, Bedani PL, Perini L. Benign nodular calcification and calciphylaxis in a haemodialysed patient. J Eur Acad Dermatol Venereol 1998;11:69-71. (Pubitemid 28383620)
48. Guermazi A, Grigoryan M, Cordoliani F, Kérob D. Unusually diffuse idiopathic calcinosis cutis. Clin Rheumatol 2007;26:268-70. (Pubitemid 46020260)
49. Boulman N, Slobodin G, Rozenbaum M, Rosner I. Calcinosis in rheumatic diseases. Semin Arthritis Rheum 2005;34:805-12. (Pubitemid 40732455)
50. Aksoy HM, Özdemir R, Karaaslan Ö, Tiftikcioglu YO, Oruç M, Koçer U. Incidental idiopathic calcinosis cutis in a rhytidectomy patient. Dermatol Surg 2004;30:1145-7. (Pubitemid 39120680)
51. Valdatta L, Buoro M, Thione A, Mortarino C, Tuinder S, Fidanza C, et al. Idiopathic circumscripta calcinosis cutis of the knee. Dermatol Surg 2003;29:1222-4. (Pubitemid 38009923)
52. Ruiz-Genao DP, Ríos-Buceta L, Herrero L, Fraga J, Aragüés M, García-Díez A. Massive scrotal calcinosis. Dermatol Surg 2002; 28:745-7. (Pubitemid 34913288)
53. Saad AG, Zaatari GS. Scrotal calcinosis: is it idiopathic? Urology 2001;57:365.
54. Pabuççuoǧlu U, Canda MS, Güray M, Kefï A, Canda E. The possible role of dartoic muscle degeneration in the pathogenesis of idiopathic scrotal calcinosis. Br J Dermatol 2003;148: 827-9. (Pubitemid 36629773)
55. Arora A, Agarwal A, Kumar S, Gupta S. Iatrogenic calcinosis cutis - a rare differential diagnosis of soft-tissue infection in a neonate: a case report. J Orthop Surg (Hong Kong) 2005;13: 195-8.
56. Meissner M, Varwig D, Beier C, Jacobi V, Kaufmann R, Gille J. Dystrophic calcinosis cutis after subcutaneous administration of para-aminosalicylic acid for treatment of pulmonary tuberculosis. J Dtsch Dermatol Ges 2006;4:489-91. (Pubitemid 43943403)
57. Lateo S, Charlton F, Hudson M, Lawrence CM. Cutaneous calcification following liver transplantation. Clin Exp Dermatol 2005;30:484-6. (Pubitemid 41076007)
58. Rivet J, Lebbe C, Urena P, Cordoliani F, Martinez F, Baglin AC, et al. Cutaneous calcification in patients with end-stage renal disease: a regulated process associated with in situ osteopontin expression. Arch Dermatol 2006;142:900-6. (Pubitemid 44079791)
59. Wilmer WA, Magro CM. Calciphylaxis: emerging concepts in prevention, diagnosis, and treatment. Semin Dial 2002;15:172-86. (Pubitemid 41765928)
60. Goyal S, Huhn KM, Provost TT. Calciphylaxis in a patient without renal failure or elevated parathyroid hormone: possible aetiological role of chemotherapy. Br J Dermatol 2000;143:1087-90.
61. Mastruserio ND, Nguyen EQ, Nielsen T, Hessel A, Pellegrini AE. Calciphylaxis associated with metastatic breast carcinoma. J Am Acad Dermatol 1999;41:295-8. (Pubitemid 29381999)
62. Ozbalkan Z, Calgunerim M, Onat AM, Ozturk MA. Development of calciphylaxis after long-term steroid and methotrexate use in a patient with rheumatoid arthritis. Intern Med 2005;44:1178-81.
63. Barri YM, Graves GS, Knochel JP. Calciphylaxis in a patient with Crohn's disease in the absence of end-stage renal disease [abstract]. Am J Kidney Dis 1997;29:773-6. (Pubitemid 27209683)
64. Swanson AM, Desai SR, Jackson JD, Andea AA, Hughey LC. Calciphylaxis associated with chronic inflammatory conditions, immunosuppression therapy, and normal renal function: a report of 2 cases. Arch Dermatol 2009;145:723-5.
65. Pollock B, Cunliffe WJ, Merchant WJ. Calciphylaxis in the absence of renal failure. Clin Exp Dermatol 2000;25:389-92.
66. Budisavljevic MN, Cheek D, Ploth DW. Calciphylaxis in chronic renal failure. J Am Soc Nephrol 1996;7:978-82. (Pubitemid 27465959)
67. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 31-2001. A 70-year-old woman with end-stage renal disease and cutaneous ulcers. N Engl J Med 2001;345:1119-24.
68. Oh DH, Eulau D, Tokugawa DA, McGuire JS, Kohler S. Five cases of calciphylaxis and a review of the literature. J Am Acad Dermatol 1999;40:979-87. (Pubitemid 29268930)
69. Weenig RH, Sewell LD, Davis MDP, McCarthy JT, Pittelkow MR. Calciphylaxis: natural history, risk factor analysis, and outcome. J Am Acad Dermatol 2007;56:569-79. (Pubitemid 46400180)
70. Bardsley S, Coutts R, Wilson C. Calciphylaxis and its surgical significance. ANZ J Surg 2005;75:356-9. (Pubitemid 40826904)
71. Fine A, Zacharias J. Calciphylaxis is usually non-ulcerating: risk factors, outcome and therapy. Kidney Int 2002;61:2210-7. (Pubitemid 34546039)
72. Perez-Mijares R, Guzman-Zamudio JL, Payan-Lopez J, Rodriguez-Fernandez A, Gomez-Fernandez P, Almaraz-Jimenez M. Calciphylaxis in a haemodialysis patient: functional protein S deficiency? Nephrol Dial Transplant 1859;11:1856-9.
73. Walsh JS, Fairley JA. Calciphylaxis. J Am Acad Dermatol 1996; 35:786-7.
74. Hafner J, Keusch G, Wahl C, Sauter B, Hürlimann A, Weizsäcker F, et al. Uremic small-artery disease with medial calcification and intimal hyperplasia (so-called calciphylaxis): a complication of chronic renal failure and benefit from parathyroidectomy. J Am Acad Dermatol 1995;33:954-62.
75. Tindni A, Kumar G, Panda M. Non-healing painful ulcers in a patient with chronic kidney disease and role of sodium thiosulfate: a case report. Cases J 2008;1:178.
76. Edwards RB, Jaffe W, Arrowsmith J, Henderson HP. Calciphylaxis: a rare limb and life threatening cause of ischaemic skin necrosis and ulceration. Br J Plast Surg 2000;53:253-5. (Pubitemid 30216410)
77. Kane WJ, Petty PM, Sterioff S, McCarthy JT, Crotty TB. The uremic gangrene syndrome: improved healing in spontaneously forming wounds following subtotal parathyroidectomy. Plast Reconstr Surg 1996;98:671-8. (Pubitemid 26292100)
78. Podymow T, Wherrett C, Burns KD. Hyperbaric oxygen in the treatment of calciphylaxis: a case series. Nephrol Dial Transplant 2001;16:2176-80. (Pubitemid 33062140)
79. Baker BL, Fitzgibbons CA, Buescher LS. Calciphylaxis responding to sodium thiosulfate therapy. Arch Dermatol 2007;143: 269-70.
80. Monney P, Nguyen QV, Perroud H, Descombes E. Rapid improvement of calciphylaxis after intravenous pamidronate therapy in a patient with chronic renal failure. Nephrol Dial Transplant 2004;19:2130-2. (Pubitemid 39139649)
81. Robinson MR, Augustine JJ, Korman NJ. Cinacalcet for the treatment of calciphylaxis. Arch Dermatol 2007;143:152-4. (Pubitemid 46294597)
82. Mohammed IA, Sekar V, Bubtana AJ, Mitra S, Hutchison AJ. Proximal calciphylaxis treated with calcimimetic 'Cinacalcet.' Nephrol Dial Transplant 2008;23:387-9.
83. Pallure V, Comte C, Leray-Mouragues H, Dereurev O. Cinacalcet as first-line treatment for calciphylaxis. Acta Derm Venereol 2008;88:62-3.