| SKIN
INVOLVEMENT: MAIN MENU |
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| Calcinosis |
| This page
was written by Shelley
Ensz, and has not yet been medically edited. Scleroderma
(SD) affects everyone differently. Just because something is
listed here does not mean an individual patient will ever experience
it. See Disclaimer. |
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| What is Calcinosis? |
 The
systemic forms of scleroderma can cause small white calcium
lumps to form under the skin on fingers or other areas of
the body.
This is called calcinosis. The lumps may break
through the skin and leak a chalky white liquid.
These most commonly occur on the hands, or near joints such
as elbows or knees, although they may appear anywhere. Calcinosis
may range from one very tiny deposit, to large (and often
painful) clusters.
A few conditions other than scleroderma may also cause calcinosis,
such as dermatomyositis, lupus,
Vitamin D, tumors, and parasitic infections. |
| Calcinosis is one of the symptoms
of CREST Syndrome,
which is a form of systemic
scleroderma. Calcinosis is not caused by too much calcium
in the diet. |
| Intraspinal (ISC) and Paraspinal Calcinosis (PSC) Associated with Systemic Sclerosis. PSC and ISC are closely associated with vascular complications in SSc, and may cause neurological manifestations crucially. Takehiko Ogawa. 8/8. ACR 2007. |
| Association between calciphylaxis and inflammation in two patients on chronic dialysis. The interactions between inflammation-mediated changes in the levels of endogenous inhibitors of calcification and abnormalities in calcium-phosphorus metabolism merit intensive study in the future as potential mechanisms of calciphylaxis. PubMed. Adv Perit Dial. 2006;22:171-4. (Also see: Dialysis) |
| Diffuse Calcinosis |
| Disappearance
of diffuse calcinosis following autologous stem cell transplantation
in a child with autoimmune disease. Liquefaction of calcinosis
nodules with improvement of mobility occurred gradually.
She is now 24 months post-transplant with no sign of disease
activity and total disappearance of calcinosis nodules. PubMed.
Bone Marrow Transplant. 2004 Apr 12. (Also see: Stem
Cell Transplant) |
| Photos of Calcinosis |
| Scleroderma
Photos: Calcinosis |
| Diagnosis |
| Sometimes calcinosis isn't visible,
and is detected only by X-ray. |
| Calcinosis
Cutis "Calcinosis cutis is a term used to describe
a group of disorders in which calcium deposits form in the
skin..." eMedicine Journal |
| A few conditions other than scleroderma
may also cause calcinosis, such as dermatomyositis, lupus,
Vitamin D, tumors, and parasitic infections. |
| Soft tissue calcifications in the lower extremities of severely diabetic patients simulating venous stasis or collagen vascular disease. Patients with severe diabetes mellitus may exhibit soft tissue calcifications of their lower extremities that may simulate the changes of venous stasis or scleroderma.PubMed. Emerg Radiol. 2006 Oct 10. (Also see: Diabetes |
| Radiological
Hand Involvement in Systemic Sclerosis. Flexion contracture
(27%), calcinosis (23%), acroosteolysis (22%), arthritis
(18%) were the main features of radiological hand involvement
in this series of patients with SSc. Calcinosis and acroosteolysis
were together associated with vascular digital and systemic
complications, which emphasize the implications of vascular
injury in such lesions. J. Avouac. FRI0095 EULAR 2005.
(Also see: Skeletal
Involvement) |
| Calcinosis
cutis universalis in a patient with systemic lupus erythematosus. Deposition
of calcium salts in the skin and subcutaneous tissue occurs
in a variety of rheumatic diseases, being most commonly associated
with scleroderma, CREST (calcinosis, Raynaud's phenomenon,
esophageal dysfunction, sclerodactyly, and telangiectasia),
dermatomyositis, and overlap syndromes but is a rare complication
of systemic lupus erythematosus (SLE). PubMed. Clin Rheumatol.
2005 May 18. (Also see: Lupus) |
| Increased
Bone Resorption and Failure to Respond to Antiresorptive
Therapy in Progressive Dystrophic Calcification. Bone
resorption was increased in patients with connective tissue
disease and severe dystrophic calcification. Several antiresorptive
agents were shown to be ineffective in limiting either bone
turnover or clinical progression in one patient. PubMed.
Calcif Tissue Int. 2003 Sep 10 (Also see: Skeletal
Involvement ) |
| Paraspinal
cervical calcifications associated with scleroderma. Although
soft tissue calcifications are well known to occur as a late
manifestation in scleroderma, symptomatic paraspinal calcinosis
is very rare. Clinically, patients present with focal neck
pain, weakness or radiculopathy, and decreased range of motion
of the neck. PubMed. JBR-BTR. 2003 Mar-Apr;86(2):80-2.
(Also see: Skeletal
Involvement) |
| Soft-tissue
mineralization in Werner syndrome. A review of previous
descriptions of the radiological abnormalities of Werner
syndrome indicates that the presence of soft-tissue calcifications
has either not been noted or been mentioned only briefly.
Moreover, there is no mention of bony masses associated with
Werner syndrome in the world literature, and this would appear
to be the first report of this kind. PubMed. Skeletal
Radiol. 2004 May 11. (Also see: Diseases
Similar to Scleroderma: Werner's Syndrome) |
| Expression
of Bone Matrix Proteins in Scleroderma Patients with and
without Calcinosis. The expression of this molecule known
to be involved in mineralization is not confined to calcified
areas, and raises the question of whether this may be the
constitutional metabolic disturbance precipitating calcinosis
in a subset of patients with SSc. Christine Davies. 1657/479.
ACR 2004. |
| Treatment |
| Generally, there is no treatment
required for calcinosis, although surgical excision is sometimes
done for extensive or very painful calcinosis. |
| Therapeutic
management of acral manifestations of systemic sclerosis. Acral
manifestations of systemic sclerosis include Raynaud's phenomenon, calcinosis
cutis, and sclerodactyly. In the later stages of the disease, contractures
of the skin and joints as well as obliterative vasculopathy leading to
digital ulcers and necrotic lesions may occur. PubMed. Med Klin (Munich).
2007 Mar 15;102(3):209-18. (Also see: Raynaud's, Sclerodactyly, Digital Ulcers, and Skeletal Involvement: Joint Contractures) |
| Calcinosis
in rheumatic diseases. While warfarin, colchicine, probenecid,
bisphosphonates, diltiazem, minocycline, aluminum hydroxide,
salicylate, surgical extirpation, and carbon dioxide laser
therapies have been used, no treatment has convincingly
prevented or reduced calcinosis. However, the approach
to calcinosis management is disorganized, beginning with
the lack of a generally accepted classification and continuing
with a lack of systematic study and clinical therapeutic
trials. PubMed. Semin Arthritis Rheum. 2005 Jun;34(6):805-12. |
| Surgical treatment of destructive calcific lesions of the cervical spine in scleroderma. Destructive, calcific masses in the cervical spine associated with scleroderma and an indication for surgical treatment are rare. Treatment is complex and not without significant risk to the patient. PubMed. Spine. 2006 Aug 1;31(17):2002-8. (Also see: Skeletal Involvement) |
| Regression
of cutis calcinosis with diltiazem in adult dermatomyositis. Calcinosis
cutis is common in several connective tissue diseases such
as dermatomyositis, scleroderma or lupus erythematous. We
report a case of adult cutis calcinosis associated with dermatomyositis
which responded dramatically to treatment with diltiazem. PubMed.
Eur J Dermatol. 2005 Mar-Apr;15(2):102-4. (Also see: Dermatomyositis) |
| Surgery
of the hand in patients with systemic sclerosis: outcomes
and considerations. The goals of surgery for advanced
SSc affecting the hand are limited and include pain relief
through sympathectomy and increased perfusion, repositioning
the digit, providing a functional position of fusion, and
modest mobilization through resection arthroplasty. J
Rheumatol. 2005 Apr;32(4):642-8. (Also see: Sclerodactyly, Skeletal
Involvement, and Raynaud's
Treatments) |
| Surgery
of the hand in severe systemic sclerosis. Thirty-three
procedures were carried out. Lesions of cutaneous calcinosis
were removed in four patients. Calcinosis was effectively
removed using a high-speed dental burr. The results of hand
surgery for systemic sclerosis are reliable, but goals must
be limited and patient expectations should be modest. PubMed.
J Hand Surg [Br]. 2004 Dec;29(6):599-603. |
| Calcinosis:
A pilot study of acetic acid iontophoresis and ultrasound
in the treatment of systemic sclerosis-related calcinosis. In
this small pilot study none of the patients experienced clinical
improvement, despite an intensive treatment schedule over
3 weeks. However, there may have been some radiographic improvement. PubMed.
Rheumatology (Oxford). 2005 Jan 11. |
| Low
dose warfarin treatment for calcinosis in patients with systemic
sclerosis. Low dose warfarin may serve as an effective
treatment for calcinosis in a selected group of patients
who have small and relatively new onset calcinosis. This
treatment does not prolong the coagulation of blood and there
is no increased tendency for bleeding. PubMed. Ann Rheum
Dis. 2004 Oct;63(10):1341-3. |
| Idiopathic
circumscripta calcinosis cutis of the knee. Calcinosis
cutis circumscripta typically involves the extremities and
is associated with prior trauma and scleroderma. Medical
therapy is not very effective. Surgical excision has shown
to be beneficial, as it can provide a symptomatic relief.
However, since calcinosis cutis limits are not always well
defined a recurrence of the lesions may occur. PubMed.
Dermatol Surg. 2003 Dec; 29(12): 1222-4. |
| Successful
palliation and significant remission of cutaneous calcinosis
in CREST syndrome with carbon dioxide laser. Treated
digits healed over a 6-week period and led to a significant
remission in symptoms. PubMed. Dermatol Surg. 2003 Sep;29(9):968-70. |
| Colchicine is
often used to reduce inflammation associated with calcinosis. MedicineNet. |
| Treatment
of cutaneous calcinosis in limited systemic sclerosis with
minocycline. Minocycline may be effective in the control
of calcinosis in systemic sclerosis. A low dose only is required
and appears to be generally well tolerated. The mechanism
of action may be mainly through inhibition of matrix metalloproteinases
and anti-inflammatory effects. Calcium binding properties
and antibacterial actions may also have a role. PubMed.
Ann Rheum Dis 2003 Mar;62(3):267-9. |
| Stories |
| (Update)
Christine S: Diffuse Scleroderma, Stage 2 It has been
three years since my story was posted on this page and trust
me, life has not slowed an iota—medically speaking
at least... |
| Craig
R: CREST Scleroderma I had my first scleroderma symptoms
at age twenty-two, which included severe Raynaud's with some
ulceration and tissue loss... |
| Debby:
CREST Scleroderma It was then everything added up—that
I did not have several different conditions, but rather they
were all part of the CREST... |
| Doni:
CREST Syndrome The doctors were always interested
like, "Wow look at this," but since I had no insurance,
they would not touch me... |
| Elaine
L: Scleroderma When I was about 20 years old, I started
experiencing stomach problems and my fingers would turn a
waxy white and feel so cold... |
| Gipi:
Raynaud's, Scleroderma (Italy) I'm a 53 year old woman.
When I was 21 my illness began, my fingers turned white and
I had pain in my bones... |
| (Italiano)
Gipi: Raynaud's, Sclerodermia Sono una donna di 53
anni. Quando avevo 21 anni ho avuto l'esordio della mia malattia
con pallore alle dita delle mani e dolori alle ossa... |
| Helen
P: CREST Scleroderma I was diagnosed ten years ago
when the symptoms kicked in with a vengeance following a
very traumatic personal tragedy... |
| Jay:
Scleroderma and CREST When I was fifteen or so, I
noticed that my fingertips were starting to get very sore... |
| Jerri:
CREST Syndrome I was twenty-one years of age when
I first noticed that my fingers, toes and lips were turning
colors... |
| Jewell:
Diffuse Progressive Systemic Sclerosis When I think
back, I had been getting sick for a long time. I just did
not know it... |
| Kathy
Baker: CREST Scleroderma (Houston, Texas) This disease
has been a roller coaster ride both emotionally and physically,
but I know it could be worse... |
| Mary
T: CREST Scleroderma If my rheumatologist does not
explain my problems to my satisfaction, I will be looking
for another doctor... |
| Pat:
CREST Scleroderma They had to do surgery and take
calcium deposits out of my knee... |
| Robin T: CREST Syndrome My hands were always cold and turning white, purple then red then back to normal, and hurting. Then I developed a sore on my finger tip that wouldn't go away... |
| Rose
M: CREST Syndrome I was finally correctly diagnosed
with CREST after two years of thinking I was going crazy... |
| Rosemary
F: Surviving Daughter of Diffuse Scleroderma Patient She
tried to explain it, but it was hard for me to comprehend
the disease's symptoms. Mom said that it was the same thing
that her oldest sister died from... |
| Sandy
A: CREST Syndrome I have had surgery to remove the
calcinosis on my knee and forearm twice, and once on my elbow.
Yet it always comes back... |
| ShaunTel:
Scleroderma/CREST Since 1993, I have had doctors telling
me so many different diagnoses that I believed I was really
just making it up... |
| Tata P: Diffuse Scleroderma I am thirty-two years old, and I have been suffering
this illness since I was nine... |
| (Español/Spanish) Tata P: Esclerodermia Difusa Hola,
tengo 32 años, y padezco esta enfermedad desde los
9... |
