| 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. |
| Vitamin D, Parathyroid Hormone, and Acroosteolysis in Systemic Sclerosis. Low levels of vitamin D may reflect silent malabsorption and might be a risk factor for secondary hyperparathyroidism and bone resorption. Y. Braun-Moscovici. J Rheumatol. Oct 1 2008. (Also see: Vitamin D Deficiency and Bone resorption) |
| 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 |
| Colchicine is often used to reduce inflammation associated with calcinosis. MedicineNet. |
| FDA to stop the marketing of unapproved injectable colchicine. Colchicine is a highly toxic drug that can easily be administered in excessive doses, especially when given intravenously. There is a narrow margin between an effective dose of the drug and a toxic dose that can result in serious health risks, including death. The FDA is aware of 50 reports of adverse events associated with the use of intravenous colchicine, including 23 deaths. News-Medical.net. 02/07/08. |
| Govt pays for deadly, unapproved drugs. Dozens of deaths have been linked to medications that have never been reviewed by the government for safety and effectiveness but are still covered under Medicaid. Comcast.net News. 11/24/08. (Also see: FDA Warnings) |
| 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... |
