Genital calcinosis cutis: Microscopic evidence supporting a dystrophic origin.

Calcinosis cutis (CC) is characterized by the deposition of calcium salts in the skin and subcutaneous tissues. CC involving the vulva or foreskin (prepuce) is uncommon. We present a 9-year-old female with vulvar CC and a 15-year-old male with preputial CC. Microscopic review of excisional specimens revealed calcification associated with follicular cysts in the vulvar case and lichen sclerosus in the preputial case, suggesting a dystrophic origin to a subset of cases of genital CC that might otherwise be classified as idiopathic. The clinical implication of these findings is the need for close histopathologic scrutiny and ongoing clinical surveillance of patients with genital CC initially deemed idiopathic.

Calcinosis Prevalence in Autoimmune Connective Tissue Diseases-A Retrospective Study.

Background/Objectives: Calcinosis cutis is the deposition of insoluble calcium salts, which may cause inflammation, ulceration, pain, and restricted joint mobility. It rarely develops in damaged tissues (dystrophic subtype), most frequently in autoimmune connective tissue diseases (CTDs), but there is very limited data on the prevalence. Also, therapy remains an unsolved issue. In this study, we aimed to collect data on the prevalence of calcinosis in CTD patients to highlight that it is a considerable problem. Methods: A retrospective study was conducted in our department to assess the epidemiology of dystrophic calcinosis in CTDs between January 2003 and January 2024. Results: A total of 839 CTD patients were identified, of whom 56 had calcinosis (6.67%). The mean age of the calcinosis patients at diagnosis of underlying CTD was 41.16 ± 19.47 years. The mean time interval from the onset of calcinosis was 5.96 ± 8.62 years. Systemic sclerosis was the most common CTD complicated by calcinosis (n = 22). Conclusions: Our results are comparable to those reported previously in the literature. Although calcinosis is rare in the overall population, it is a present and unsolved problem in CTD patients. Therefore, further studies are needed on the factors involved in the development and progression of calcinosis as well as its treatment.

Unusual Presentation of Recurrent Calcinosis Cutis in the Right Thumb of a 16-Year-Old Female.

Calcinosis cutis is a quite unusual disease represented by abnormal accumulation of calcium salts in the skin and subcutaneous tissues. Repeated cutis calcinosis means recurrent calcium deposition in pre-existing areas. The case report illustrated the case of a 16-year-old female who had recurrent calcium deposits on the base of her right thumb. The patient initially had swelling at the base of her right thumb, which had been present for six months now. The patient described the dorsal solid mass on top of the thumb base, which was painful and had reduced thumb mobility. There was swelling that became painful, specifically located at the same site as the previous surgery, with thumb restriction and superadded infection at the metacarpophalangeal joint. Routine lab tests, including blood tests and rheumatologic and autoimmune work-ups, were normal. Plain radiographs and ultrasound examinations unveiled the characteristics of calcifications in the thumb tissues. A skin biopsy was done and the calcium deposits in subcutaneous tissue were confirmed, matching calcinosis cutis. The approach to the treatment of this condition entailed conservative measures. Some included physiotherapy to correct a flexion deformity, antibiotics, painkillers, and daily dressing. The patient was advised to follow up and to consider excision of the nodules. This case points out the clinical manifestations, investigations, and initial management of available strategies for recurrent calcinosis cutis. Further studies and long-term follow-up are necessary to determine the optimal treatment approaches and outcomes for this rare condition.

Treatment of calcinosis cutis associated with autoimmune connective tissue diseases.

Calcinosis cutis is a condition that is commonly associated with autoimmune connective tissue diseases. It is characterized by the deposition of insoluble calcium salts in the skin and subcutaneous tissue, which can cause pain, impair function, and have significant impacts on quality of life. Calcinosis cutis is difficult to manage because there is no generally accepted treatment: evidence supporting treatments is mostly comprised of case reports and case series, sometimes yielding mixed findings. Both pharmacologic and procedural interventions have been proposed to improve calcinosis cutis, and each may be suited to different clinical scenarios. This review summarizes current treatment options for calcinosis cutis, with discussion of recommendations based on patient-specific factors and disease severity.

Metastatic Calcinosis Cutis: Unusual Locations in End-Stage Renal Disease.

Metastatic calcinosis cutis is a rare consequence of end-stage renal disease (ESRD), which occurs due to elevated levels of serum phosphorus and abnormal phosphate and calcium metabolism, leading to the precipitation and deposition of calcium in the cutaneous and subcutaneous tissues. This paper reports the case of a 33-year-old male with ESRD and a six-year history of hemodialysis treatment who presented with multiple areas of gradually enlarging, lobulated calcified soft tissue masses observed bilaterally at the level of the acromioclavicular joint and superomedial aspect of the right thigh, extensively involving the perineal region and the right superior anterior chest wall. The unique character of this case is the rare involvement of the sternoclavicular joint and the symphysis pubis. The relevant laboratory findings included elevated levels of serum phosphorus, blood urea nitrogen, and creatinine, which were consistent with metastatic calcinosis cutis as a consequence of ESRD. The treatment of secondary calcinosis cutis primarily includes low-calcium and low-phosphorus diets, dialysates, and phosphate binders, except aluminum-containing binders, which were advised for this patient. Imaging is the mainstay for the diagnosis of calcinosis cutis, and as metastatic calcinosis cutis is an infrequent and debilitating consequence of ESRD, prompt diagnosis and appropriate treatment are paramount.

Idiopathic scrotal calcinosis: Is the cause still unknown? A case report.

INTRODUCTION AND IMPORTANCE: Idiopathic Scrotal Calcinosis (ISC) is a rare and benign dermatological condition, characterized by the formation of calcified nodules on the scrotal skin. CASE PRESENTATION: A 47-year-old man with a 15-year history of painless, chamois-colored nodules on his scrotum. Surgical excision of the affected skin was performed, followed by primary closure, with histopathological examination confirming ISC. The patient recovered well with no recurrence noted at a 14-month follow-up. CLINICAL DISCUSSION: The etiology of ISC remains uncertain, with theories ranging from dystrophic calcification of epidermal cysts to Dartos muscle degeneration. In this case, no signs of epithelial cells or anatomical structure degeneration were observed, supporting the idiopathic nature of ISC. Treatment is typically surgical and aimed at aesthetic or symptomatic relief. While surgery is generally effective, the literature indicates a variable risk of recurrence, underscoring the need for long-term follow-up. CONCLUSION: This report contributes to the understanding of ISC, highlighting its idiopathic nature and the diversity of its etiological theories. It reinforces the effectiveness of surgical treatment for symptomatic relief and underscores the importance of ongoing research to elucidate the condition's etiology and optimize patient care.

Eruptive syringomas associated with milia-like idiopathic calcinosis cutis.

An 11-year-old boy presented generalized eruptive syringomas (ESs) associated with multiple milia-like whitish palmar papules corresponding to dermal calcium deposits. A relationship between calcium deposits distribution to an underlying eccrine duct was noted on pathology. The observation of dermal calcium deposits and its association with generalized ESs may support a possible sweat duct origin of this uncommon and peculiar form of superficial calcinosis cutis.

A case report and review of calcinosis cutis.

Commonly associated with autoimmune and renal disorders, calcinosis cutis is a disorder of systemic calcium deposition in soft tissues. The pathophysiology of such deposition varies based on subtype, therefore treatment options vary not only in terms of severity of disease but also with subtype. This case report describes a 52-year-old female with systemic sclerosis and an extensive past medical history who initially presented with complaints of worsening left lower leg pain, a negative workup for deep vein thrombosis, and an extensive palpable mass in the posterior thigh with erythema, drainage, and purulence. With multiple treatment options exhausted from her autoimmune disorders, she ultimately required surgical resection for her refractory infected calcinosis cutis. Identification of calcinosis cutis subtype in conjunction with appropriate history and physical is crucial to determining indications for treatment.

Idiopathic calcinosis cutis in an infant: The importance of a wait-and-see approach.

A healthy 2-year-old girl presented with multiple asymptomatic subcutaneous nodules on both legs. Histologically demonstrated calcium deposition within the dermis and subcutaneous tissue consistent with calcinosis cutis. Laboratory abnormalities, underlying genetic conditions, and potential triggering factors were ruled out. The lesions resolved over an 18-month period without treatment, emphasizing the importance of the wait-and-see approach in idiopathic cases of calcinosis cutis.

Systemic Sodium Thiosulfate as an Adjunct Treatment in Calcinosis: A Retrospective Study.

(1) Background: Calcinosis of the skin mainly appears in connective tissue disorders (dystrophic subtype). It may cause inflammation, ulceration, pain, and restricted joint mobility. Management is difficult; sodium thiosulfate is one potential therapeutic agent with promising data on intralesional and topical formulation for smaller calcified lesions. There are very limited data on systemic administration. (2) Methods: A retrospective study was conducted at our department to assess the efficacy of oral and intravenous sodium thiosulfate in dystrophic calcinosis between 2003 and 2023. (3) Results: Seven patients were identified, who received systemic sodium thiosulfate (intravenous or oral). The mean duration of calcinosis at the time of administration was 3.8 ± 4 years (range 0-11). Intravenous sodium thiosulfate was administered in doses of 12.5-25 g two or three times during one week of the month for 4.5 ± 3.9 months on average. Orally, 1-8 g was administered daily for 29.1 ± 40.9 months on average. Four of seven patients had a partial response (57.1%). Despite no complete response, pain, ulceration and inflammation frequency decreased, and sodium thiosulfate prevented further progression in responsive patients. (4) Conclusions: Based on our experience and literature data, systemic sodium thiosulfate may be a potential adjunct therapy in calcinosis, especially if inflamed or ulcerating.

When the Going Gets Tough: A Case Report and Review of Calcinosis Cutis in an Infant with Pseudo-Hypoaldosteronism.

Calcium gluconate solutions are an essential part of the intensive care medication armamentarium. Calcium-related extravasations are not an infrequent occurrence. However, occult extravasation presenting solely as an isolated mass lesion with no preceding cutaneous manifestation is rare. Calcinosis cutis is an extraosseous collection of calcium deposits in the skin and subcutaneous tissues. Multiple etiopathogenetic factors play a role in its manifestations. We illustrate a case of a seven-week-old infant diagnosed with pseudo-hypoaldosteronism with a mysterious swelling on the left leg during the third week of hospitalization, which was attributed to occult iatrogenic calcinosis cutis.

Subepidermal Calcinosis Cutis of Ear: Case Report with Review of Literature.

Subepidermal Calcified Nodule of Ear is an uncommon lesion which is a type of Idiopathic Calcinosis Cutis. It is characterised by calcium deposits in an otherwise normal tissue with no underlying defects in Calcium or phosphorus homeostasis. With an unknown etiopathogenesis, it is usually seen in the paediatric age group. Final diagnosis need a clinicopathological correlation and it underlines the importance of post operative lab investigations which the patient must undergo to rule out any other underlying pathology. We present case of an 8 year old girl with subepidermal calcified nodule of left ear auricle which is a rare occurrence.

Neonatal iatrogenic calcinosis cutis caused by calcium gluconate extravasation.

BACKGROUND: Calcium gluconate is widely used to treat neonatal hypocalcemia, severe hyperkalemia, and convulsions. However, extravasation of calcium gluconate can lead to iatrogenic calcinosis, causing symptoms such as local redness and swelling, cutaneous plaque, soft tissue calcification, and cutaneous tissue necrosis. Therefore, this study retrospectively analyzed the conservative treatment results of neonatal iatrogenic calcinosis. METHODS: Data of neonates diagnosed with iatrogenic calcinosis cutis caused by calcium gluconate exudation between December 2012 and June 2021 were analyzed retrospectively. The clinical data included medical history, physical examination, laboratory findings, and radiographs. All the patients were conservatively treated, and the curative effect and prognosis were followed up by evaluating radiographs and limb function. Patients with complications, such as recurrence or limb dysfunction, were further followed up. RESULTS: Overall, 16 neonates (sex: 10 male and 6 female infants; age: 17.5 ± 7.8 days) were included. Iatrogenic calcinosis cutis was located around the left wrist, right wrist, left ankle, and right ankle in four, one, six, and five patients, respectively. Calcification healed within 1-3 months (mean: 1.6 ± 0.6 months). After a follow-up of 0.5-8.5 years (mean: 3.5 ± 2.8 years), the appearance, joint function, local growth, and development of the lesion of the neonates with iatrogenic calcinosis cutis were consistent with those of the healthy ones. CONCLUSION: For neonatal iatrogenic calcinosis cutis without cutaneous and subcutaneous tissue necrosis, symptomatic support treatment is effective and does not affect the limbs' appearance and function.Level of evidence: IV.

Case of calcinosis cutis associated with Sjogren's syndrome.

Calcinosis cutis is a chronic condition involving skin and soft tissue deposition of calcium and phosphate. It is associated with several conditions including idiopathic, iatrogenic, malignant metastasis, calciphylaxis, and connective tissue diseases. The most common connective tissue diseases it is associated with include systemic sclerosis and dermatomyositis. We present a case image of a patient with Sjogren's syndrome and calcinosis cutis and its progression over time. The patient was optimized on her current treatment regimen to prevent further progression. Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.

Muscular Weakness with Calcinosis Cutis_A Case of Juvenile Dermatomyositis in a South Asian Male.

Background: Juvenile dermatomyositis (JDM) is an autoimmune connective tissue disorder characterized by an inflammation of proximal muscles of both upper and lower limbs in children below the age of 18 years. The condition mainly involves the proximal muscles and skin but extra-muscular involvement such as the gastrointestinal tract, lungs, and heart are also common. Case presentation: We present a case of a 12-year-old south Asian male who developed weakness and muscular pain in all 4 extremities at 3 years of age. The condition gradually worsened recently, and the patient developed tender ulcerated skin nodules. Power in all 4 limbs was decreased and the patient was not able to perform his routine work such as combing of hair, closing a shirt button, and walking. Laboratory investigations revealed raised total leukocyte count (TLC) and erythrocyte sedimentation rate (ESR) and biopsy of the proximal muscles and skin lesions showed focal mild necrotic infiltrate involving nonnecrotic muscle fibers and calcinosis cutis respectively. A diagnosis of JDM was made and the patient was started on immunosuppressive therapy (steroids) and diltiazem. Conclusion: JDM shares clinical features with other autoimmune, genetic, and inflammatory conditions. Proper history, thorough clinical examination, and laboratory workup is needed to rule out other masquerading conditions. This case report also highlighted the importance of diltiazem in the treatment of calcinosis cutis which is more commonly seen in patients with dermatomyositis.

Calcinosis Cutis and Calciphylaxis in Autoimmune Connective Tissue Diseases.

Calcinosis represents a severe complication of several autoimmune disorders. Soft-tissue calcifications have been classified into five major types: dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis. Autoimmune diseases are usually associated with dystrophic calcifications, including calcinosis cutis, occurring in damaged or devitalized tissues in the presence of normal serum levels of calcium and phosphate. In particular, calcinosis cutis has been described in dermatomyositis, polymyositis, juvenile dermatomyositis, systemic sclerosis, systemic lupus erythematosus, primary Sjögren's syndrome, overlap syndrome, mixed connective tissue disease, and rheumatoid arthritis. Calciphylaxis, a severe and life-threatening syndrome presenting with vascular calcifications and thrombosis, has also been associated with some autoimmune conditions. Due to the potentially disabling character of calcinosis cutis and calciphylaxis, physicians' awareness about the clinical presentation and management of these diseases should be increased to select the most appropriate treatment option and avoid long-term complications. In this review, we aim to analyze the clinical features of calcinosis cutis and calciphylaxis associated with autoimmune diseases, and the main treatment strategies evaluated up to now for treating this potentially disabling disease.

Mobile Subcutaneous Calcinosis Cutis: A Case Report of a Mobile Solitary Subepidermal Calcified Nodule on a Woman's Leg and a Review of Mobile Subcutaneous Tumors.

Calcinosis cutis describes the deposition of calcium in the dermis. A case of a 69-year-old woman with idiopathic calcinosis cutis that presented as a mobile subcutaneous nodule is described. The patient had an asymptomatic, firm, mobile subcutaneous nodule on her right lower leg of at least six months duration. The nodule could be easily moved from one location to another. An incisional biopsy was performed. Microscopic examination of the tissue specimen showed islands of basophilic calcium material in dense sclerotic dermal connective tissue establishing the diagnosis of calcinosis cutis. Mobile solitary calcification is an unusual presentation of idiopathic calcinosis cutis. In addition to idiopathic calcinosis cutis, benign mobile subcutaneous tumors have also been derived from adnexal structures of hair follicles and adipose tissue. Hence, not only idiopathic calcinosis cutis, but also subepidermal calcinosis in the ocular adnexa, proliferating trichilemmal cyst with focal calcification, and mobile encapsulated adipose tissue can present as a mobile subcutaneous nodule. The features of idiopathic calcinosis presenting as a mobile subcutaneous nodule as well as the characteristics of other benign mobile subcutaneous tumors are reviewed.

Clinico-cytomorphological Spectrum of Calcinosis Cutis.

Introduction: The deposition of calcium in the skin is known as calcinosis cutis. It can affect any part of the body and can mimic soft tissue or bony lesions clinically. Aim: To describe the clinical and cytomorphologic features of calcinosis cutis on fine needle aspiration cytology smears. Materials and Methods: A total of 17 cases reported as calcinosis cutis on fine needle aspiration cytology were reviewed for the available clinical and cytological details. Results: The cohort included both adult and pediatric patients. Clinically, the lesions appeared as painless swellings of variable sizes. The common sites affected were the scrotum, iliac region, scalp, pinna, neck, axilla, elbow, arm, thigh, and gluteal region. Aspirate was chalky white, paste-like in all the cases. The cytologic evaluation revealed amorphous crystalline deposits of calcium along with histiocytes, lymphocytes, and multinucleated giant cells. Conclusions: Calcinosis cutis has a wide spectrum of clinical presentations. Fine needle aspiration cytology is a minimally invasive approach for diagnosing calcinosis cutis, thus eliminating the need for more extensive biopsy procedures.