Calcinosis Cutis

Calcinosis cutis refers to calcium deposits in the skin seen in many different conditions. The image shown here is from a patient with dermatomyositis. The typical sheet-like calcifications, though pathognomonic, are uncommon and not seen here. What we do see are multiple subcutaneous calcifications, many of which have lucent centers (think mammo). Patients with juvenile dermatomyositis are 3 times more likely to develop calcifications compared to the adult-onset form. Calcifications tend to occur over joints and spare the digits.

Calcinosis cutis can be seen in the setting of:

• Normal serum calcium and phosphate levels (dystrophic calcinosis): Trauma, inflammation, varicose veins, infections (e.g., onchocerciasis, cysticercosis, histoplasmosis, cryptococcosis, and intrauterine herpes), tumors, connective tissue diseases (dermatomyositis, lupus erythematosus [rare], systemic sclerosis), panniculitis (e.g., pancreatitis or pancreatic malignancy), and congenital (Ehlers-Danlos syndrome, Werner syndrome, pseudoxanthoma elasticum, and Rothmund-Thompson syndrome).
• Abnormal calcium or phosphate metabolism (metastatic calcinosis): Primary or secondary hyperparathyroidism, paraneoplastic (bone metastases or abnormal hormone production), milk-alkali syndrome, vitamin D overconsumption, and sarcoidosis (1,25-vitamin D produced by sarcoid granuloma).
• No known tissue injury or systemic metabolic defect (idiopathic calcinosis):
• Prior surgical procedure (iatrogenic calcinosis):

References

Nunley JR and Jones LME. Calcinosis Cutis. eMedicine. Jan 27, 2009