Search

Resumen La calcinosis cutis (CC) se define como el deposito de sales de calcio en la piel. Esta entidad se clasifica en 5 tipos que incluyen la CC distrofica, metastasica, idiopatica, iatrogenica y calcifilaxis. La calcificacion distrofica constituye el tipo mas frecuente y aparece principalmente en enfermedades autoinmunes. El tratamiento de la CC incluye la extirpacion quirurgica o el uso de farmacos como diltiazem, bifosfonatos, warfarina, ceftriaxona, probenecid, minociclina e hidroxido de aluminio. La calcifilaxis se define como la calcificacion de la capa media de vasos de pequeno y mediano tamano de la dermis y tejido celular subcutaneo. Clinicamente se manifiesta como un sindrome de livedo racemosa que progresa a purpura retiforme y necrosis cutanea. La primera linea de tratamiento es el tiosulfato sodico. El objetivo de esta revision es proporcionar un analisis de los diferentes trastornos de calcificacion cutanea enfocada en su diagnostico y tratamiento.

Calcinosis cutis (CC) is defined as the deposition of calcium salts in the skin. The condition is divided into 5 types: calciphylaxis and dystrophic, metastatic, idiopathic, and iatrogenic CC. Dystrophic CC is the most common form and usually occurs in association with autoimmune diseases. CC can be treated surgically or with the use of drugs such as diltiazem, bisphosphonates, warfarin, ceftriaxone, probenecid, minocycline, or aluminum hydroxide. Calciphylaxis is defined as calcification of the media of small- and medium-sized blood vessels in the dermis and subcutaneous tissue. Clinically, calciphylaxis causes livedo racemosa, which progresses to retiform purpura and skin necrosis. First-line treatment is with sodium thiosulfate. We present a review of the calcifying disorders of the skin, focusing on their diagnosis and treatment.

This article reviews the most updated literature regarding the epidemiology, pathophysiology, diagnosis, and treatment of calcinosis cutis in patients with systemic sclerosis (SSc).Our review identified observational studies that describe the frequency of calcinosis in SSc and associated clinical features, genetic studies in animal models of heritable disorders leading to calcium deposition, and case series and case reports describing new diagnostic approaches and therapeutic interventions.Calcinosis cutis is the deposition of calcium in the skin and subcutaneous tissues. It affects almost one quarter of patients with SSc, and is associated with longer disease duration, digital ulcers, acroosteolysis, positive anticentromere antibody, and positive anti-PM/Scl antibody. Local trauma, chronic inflammation, and vascular hypoxia have been proposed as potential pathomechanisms. The development of mouse models that mimic heritable ectopic mineralization disorders are contributing to the understanding of the process of calcification. Diagnosis can be made clinically or with plain radiography. Experimental diagnostic studies include ultrasonography, multidetector computed tomography, and dual-energy computed tomography. Several pharmacologic therapies have been tried for calcinosis with variable results, but surgical excision of calcium deposits remains the mainstay of treatment.

Juvenile dermatomyositis is a rare, chronic autoimmune disorder commonly associated with calcinosis cutis. Although great advances have been made in the treatment of juvenile dermatomyositis, little progress has been made in the treatment of calcinosis cutis. It remains resistant to medical treatment and surgical intervention has long been avoided due to early reports of poor wound healing and sinus track formation associated with the surgical excision of calcinosis cutis. The literature on management of calcinosis cutis is sparse and the aim of this paper is to review the literature regarding treatment options for calcinosis cutis and present a case with a large mass involving the elbow that was successfully treated with surgical excision and local fasciocutaneous flap.

A 45 year old male presented with multiple, painless, hard nodular swelling over scrotum of two years duration. The nodules gradually increased in size. There was no history of trauma or any systemic illness. A provisional diagnosis of sebaceous cyst of scrotum was made. His haematological and biochemical parameters were normal. En-block excision of lesion was done. Histopathological diagnosis of calcinosis cutis was made and confirmed by Von Kossa stain. We report herewith a case of idiopathic calcinosis cutis of scrotum and review the literature regarding pathogenesis and management.

We report a case of calcinosis cutis presenting in the upper eyelid. These cases can mimic various conditions of the eyelid and diagnosis is usually done histopathologically. Though they are common occurrence for dermatologists, there are very few cases reported in the ophthalmic literature. They need to be recognised and differentiated from a more dangerous metastatic and dystrophic varieties as simple excision is adequate in the idiopathic type of calcinosis cutis.

Milia-like idiopathic calcinosis cutis (MICC) is a very rare dermatological disorder characterized by multiple whitish to skin colored, milia-like papules, mostly found on the hands. MICC can disappear spontaneously by adulthood; therefore, its early recognition is crucial to avoiding unnecessary interventions. Herein, we present a case of MICC in a 6-year-old girl with Down syndrome.

We present two cases of patients with systemic autoimmune diseases (one with dermatomyositis and one with CREST syndrome) who presented with a worsening of calcinosis cutis after treatment of osteoporosis with teriparatide. To our knowledge, this association is not described in the literature and might be considered in the spectrum of adverse reactions to teriparatide.

We report a case of pituitary-dependent hyperadrenocorticism in a 10-year-old, female, terrier dog. The animal was admitted due to polyphagia, weight gain, polyuria, polydipsia, hair loss, exercise intolerance and panting at rest. On physical examination, abdominal distention, truncal and bilaterally symmetric alopecia, thin hypotonic skin, comedones, bruising, hyperpigmentation and calcinosis cutis on the dorsal midline were observed. Hematologic investigations showed stress leukogram, high serum alkaline phosphatase activity, mild to moderate alanine aminotransferase activity, hypercholesterolemia, hypertriglyceridemia and hyperglycemia. Mild generalized interstitial lung patterns and hepatomegaly were detected in the radiographs. Bilaterally symmetric normal-sized adrenal glands were also diagnosed in ultrasonography. Diagnosis of pituitary-dependent hyperadrenocorticism was confirmed with low-dose dexamethasone suppression test. The dog was successfully treated with mitotane.

Calcinosis cutis is a condition in which calcium salts are deposited in the skin and subcutaneous tissue due to various causes. These deposits are classified as dystrophic, metastatic, idiopathic, and iatrogenic calcifications [1]. Dystrophic calcification is characterized by damaged or abnormal local tissues without elevated serum calcium and phosphate levels. Metastatic calcification is caused by abnormal calcium and/or phosphate metabolism. Idiopathic calcification occurs even in the absence of tissue damage or metabolic disorders. Moreover, calcification may also occur as a result of tissue damage or impaired mineral metabolism after medical interventions [2]. We experienced a case of an 18-year-old man who had been diagnosed with acute lymphoblastic leukemia (ALL) as a child and developed iatrogenic calcinosis cutis due to the extravasation of intravenous anticancer drugs. Here, we report our case with a review of the literature. In January 2015, a patient initially diagnosed with ALL in June 2001 visited us for the further evaluation and treatment of a mass. Until September 2004, the patient had been treated with methotrexate, vincristine, and cyclophosphamide at the outpatient clinic of the Department of Pediatrics. In 2002, the patient exhibited extravasation of intravenous anticancer drugs on the dorsum of the right hand. At that time, the patient presented with pain, swelling, redness, and tender inflammation. Over two weeks, the redness and inflammation had improved, but the lesion exhibited a gradual tendency towards firmness. A routine laboratory test showed calcium levels of 9.9 mg/dL and inorganic phosphate levels of 5.4 mg/dL. In February 2007, the patient experienced a relapse of ALL. Until August 2010, the patient received secondary chemotherapy using the same drugs. During this period, in 2008, the patient experienced extravasation of intravenous anticancer drugs on the elbow of the right arm. As in 2002, the patient developed a larger mass two weeks later. A routine laboratory test showed calcium levels of 9.5 mg/dL and inorganic phosphate levels of 5.3 mg/dL. Both masses persisted without changes in their size (Fig. 1). Fig. 1 Preoperative view of the patient. (A) The mass on the dorsum of the right hand. (B) The mass on the elbow of the right arm. On radiography, the patient had a radiopaque lesion at the site of each mass. On sonography, the patient had calcified lesions in the subcutaneous fat layer; the lesion on the dorsum of the right hand measured 3.0×1.1×0.5 cm, and the lesion on the elbow of the right arm measured 4.0×2.6×1.3 cm. These findings were interpreted as a heterotopic ossification. On January 21, 2015, the patient underwent resection of the mass under general anesthesia. Intraoperatively, two subcutaneous encapsulated masses were found: one was found on the dorsum of the right hand and measured 2.4×1.5×0.5 cm, and the other was found on the elbow of the right arm and measured 5.2×2.8×1.4 cm (Fig. 2). Postoperatively, the patient underwent tissue biopsy and was diagnosed with calcinosis cutis (Fig. 3). Thereafter, the patient underwent follow-up at our outpatient clinic, but showed no episodes of recurrence. Fig. 2 Intraoperative view of the patient. (A) The mass on the dorsum of the right hand. (B) The mass on the elbow of the right arm. Fig. 3 Pathologic image showing calcium salts, which can be recognized as either fine granules or small deposits in the dermis (H&E, ×100). Calcinosis cutis may be misdiagnosed as cellulitis, osteomyelitis, arthritis, abscess, periostitis, myositis ossificans, and thrombophlebitis. It is frequently encountered in a clinical setting. When a preoperative X-ray or sonography shows heterotopic ossification, differential diagnoses should include osteoma cutis and calcinosis cutis. Osteoma cutis is a condition in which bone tissue is formed on the skin, with the emergence of a focus of calcification arising from the inflammatory scar or from a granuloma of bony tissue. In contrast, calcinosis cutis is characterized by the deposition of calcium salt in the skin and soft tissue, with the involvement of bony tissue. The pathogenesis of calcinosis cutis has not been fully elucidated. However, many factors causing this disease have been established, and different clinical scenarios, involving various forms of calcinosis cutis, arise from different causes. Tumoral calcinosis is characterized by calcium deposition around joints, and appears in healthy adolescents. It is a type of metastatic calcification that accompanies hyperphosphatemia, and develops after swelling without pain at the major joints such as the shoulder, hips, and elbows. Leukemia cutis occurs with paraneoplastic hypercalcemia due to bony metastases or the production of an abnormal hormone that directly affects calcium and bone metabolism. According to Lestringant et al. [3], this disease is widespread and mainly affects the blood vessels, kidneys, lungs, and gastric mucosa, as well as the skin or subcutaneous tissue. Furthermore, diffuse osteoporosis or spontaneous fractures of small bones may appear. In our case, it was possible to distinguish the clinical course of tumoral calcinosis from leukemia cutis. When the mass first developed, the patient's serum calcium levels were within the normal range and phosphate was slightly elevated, but within the normal range considering that the patient was a child at the time. Therefore, we were able to exclude metastatic calcification with hyperphosphatemia and hypercalcemia. Unlike the general pattern of occurrence observed in diffuse leukemia cutis, the mass arose at the venipuncture site after intravenous injections, subsequent to pain, swelling, and redness. Some case reports have described iatrogenic calcinosis cutis as a complication of the intravenous use of calcium chloride or calcium gluconate [4]. These authors have also noted that iatrogenic calcinosis cutis occurs between two hours and 24 days after extravasation, with an average delay of 13 days [5]. The case of our patient corresponded to this pattern, with calcinosis cutis caused by the extravasation of calcium solutions. The patient developed a mass two weeks after the extravasation of anticancer drugs, which is consistent with the clinical manifestation of calcinosis cutis arising from the extravasation of calcium chloride. According to Goldminz et al. [5], the pathophysiology of calcinosis cutis is based on tissue damage arising from the extravasation of a solution followed by the deposition of crystalline or insoluble calcium phosphate minerals. However, we did not use intravenous calcium therapy. We assume that this case was solely caused by the extravasation of anticancer drugs. The tissue damage caused by the extravasation of anticancer drugs may be assumed to have played an important role in the onset of calcinosis cutis. This is the first case report of calcinosis cutis caused by the extravasation of intravenous anticancer drugs. We believe that our rare case may help elucidate the pathogenesis of calcinosis cutis.

Calcinosis cutis is an uncommon condition characterized by the deposition of calcium salts in the subcutaneous tissues of the body. Calcifications can also occur in a variety of other clinical settings and can be subjected to fine-needle aspiration (FNA). Since cutaneous calcific deposits may clinically mimic a tumor, it is feasible to diagnose them by FNA cytology (FNAC). We reported a case of calcinosis cutis by FNA in a 36-year-old male who presented with a solitary subcutaneous nodule in cubital fossa. Smears showed amorphous granular material consistent with calcium and occasional histiocytes. The diagnosis was confirmed when cytosmears were subjected to a special stain such as the von Kossa stain.

Calcinosis cutis is a condition of accumulation of calcium salts within the dermis leading to the formation of a calcified mass. This complication has been reported in acne vulgaris and other systemic metabolic disorders. This paper presents a rare case of calcinosis cutis in a 14-year-old male which was found at a routine orthodontic assessment.

Idiopathic calcinosis cutis is very rare and difficult to treat. Various medical modalities of treatment described with inconsistent results include chelating agents, colchicine, and probenecid. Calcium channel blockers are known to work by inhibiting intracellular entry of calcium. We successfully treated a case of idiopathic calcinosis cutis using oral diltiazem.

Background Hepatobiliary involvement (HBI) has been associated to systemic sclerosis (SSc). However, it is not considered as characteristic clinical manifestation of that autoimmune disease Objectives To assess the prevalence and causes of HBI in SSc and to investigate the clinical characteristics and prognosis of SSc patients with HBI (SSc-HBI) and without HBI (SSc-non HBI). Methods Up to January 2015, 1572 SSc patients were collected in the Registro de ESCLErodermia (RESCLE) and causes of hepatobiliary disturbances were recorded. We investigated the HBI related characteristics and survival from the entire cohort and according to the following cutaneous subsets: dcSSc, lcSSc, and SSc sine scleroderma (ssSSc). Results Out of 1572, 118 (7.5%) patients had HBI, and primary biliary cholangitis (PBC) was largely the main cause (n=67, 4.3%), followed by autoimmune hepatitis (n=19, 1.2%), and anti-mitochondrial negative PBC (n=6, 0.4%). Other causes of HBI were: secondary liver diseases (n=11, 0.7%), SSc-related HBI (n=7, 0.4%), nodular regenerative hyperplasia (n=3, 0.2%), liver cirrhosis (n=3, 0.2%), and unknown origin (n=2, 0.1%). In multivariate analysis, HBI was independently associated to lesser risk of dcSSc (5.1% vs 24.4%, OR: 0.18, p=0.005%), and higher frequency of calcinosis (26% vs 18%, OR: 1.80; p=0.028), left ventricular diastolic dysfunction (46% vs 27%, OR: 1.73; p=0.027), sicca syndrome (51% vs 29%, OR: 2.03; p=0.003), and anti-centromere antibodies (ACA, 73% vs 44%, OR: 1.86; p=0.023). According to the cutaneous subsets, HBI was associated: (1) in lcSSc subset, to longer time from SSc onset to diagnosis (10.8±12.5 vs 7.2±9.3, OR: 1.03; p=0.012), sicca syndrome (54% vs 33%, OR: 1.96; p Conclusions The prevalence of HBI in SSc was 7.5%. Primary autoimmune liver diseases accounted for 77% of all conditions. PBC was the main cause of HBI reaching 4.6% of the overall SSc cohort. Patients with HBI were rarely classified as dcSSc subset and the elapsed time from the first SSc symptom to SSc diagnosis was longer. Calcinosis cutis, diastolic dysfunction, sicca syndrome, and the presence of ACA were all independently associated to HBI. In lcSSc subset, HBI was associated to sicca syndrome and ACA but in ssSSc only sicca syndrome was more prevalent. HBI was the cause of death in 2.3% References Assassi S., Fritzler MJ, Arnett FC, et al., Primary biliary cirrhosis (PBC), PBC autoantibodies, and hepatic parameter abnormalities in a large population of systemic sclerosis patients. J Rheum 2009; 36: 2250–2256. Rigamonti C, Shand LM, Feudjo M, et al. Clinical features and prognosis of primary biliary cirrhosis associated with systemic sclerosis. Gut 2006; 55; 388–394. Disclosure of Interest None declared

Nail involvement has rarely been recognized in systemic sclerosis (SSc). Indeed, only a few small series have assessed nail changes in SSc, most of which are case reports.The aims of the current case-control study were to: (1) determine the prevalence of fingernail changes in SSc; and (2) evaluate the correlation between fingernail changes and other features of SSc.In all, 129 patients with SSc and 80 healthy control subjects underwent routine fingernail examination.The prevalence of fingernail changes was 80.6% in SSc. Patients with SSc more frequently exhibited: trachyonychia (P = .006), scleronychia (P .0001), thickened nails (P .0001), brachyonychia (P = .0004), parrot beaking (P .0001), pterygium inversum unguis (P .0001), splinter hemorrhages (P .0001), and cuticle abnormalities (P .0001) than healthy control subjects. The presence of fingernail changes was associated with digital ulcers (P .0001), calcinosis cutis (P = .004), and higher values of mean nailfold videocapillaroscopy score (P = .0009).The cohort originated from a single center.This study underlines that fingernail changes are correlated with more severe forms of SSc characterized by digital microangiopathy, including digital ulcers and calcinosis cutis. Nail changes should be systematically checked in all patients with SSc, and may be included in the American College of Rheumatology/European League Against Rheumatism classification criteria for SSc.

Background Systemic sclerosis (SSc) is characterized by fibrosis, autoimmunity and vasculopathy. ES is classified subtypes: diffuse (dSSc) and limited (ISSc). More than 35% develop calcinosis. Calcium, phosphorus, parathormone, vitamin D, TGF-β, nitric oxide and osteonectin and osteopontin involved in bone mineralization. Objectives The aim was to compare osteonectin (ON), osteopontin (OP), TGF-β, nitric oxide (NO), Paratohormone (PTH), Vitamin D and minerals concentrations in ES with and without calcinosis. Methods Cross-sectional study in ES patients (ACR criteria). We quantified OP, ON, TGF-β, ON, Calcium, Phosphorus, PTH and vitamin D in serum by ELISA. We performed descriptive statistics, Student t, Pearson correlation (significance p Results We included 71 patients, age 52.94 (± 11.47); 28 (40%) with calcinosis (18 dSSc/10 lSSc), and 43 (60%) without calcinosis (13 dSSc/30 lSSc). Biochemical parameters between two groups. In the whole population the higher PCR had moderate positive correlation (r =0.41, p=0.042), and serum calcium level had a moderate negative correlation (r = -0.47, p=0.021); ON increased in direct relation to OP (r =0.3, p=0.014) and the serum levels of VitD had lower indirect relation with the evolution time of SSc (r = -0.28, P=0.025) and the ON increase in direct relation to serum creatinine (r =0.039, p=0.006). Conclusions Patients with a longer time evolution of SSc have less serum levels of VitD and those with higher inflammation (PCR) have a higher TGF-β than a potent inducer of fibrosis. PCR and TGF-B have a moderate direct correlation, PCR and Calcium have moderate indirect correlation, ON and OP have a low direct correlation, VitD and evolution of diseases (years) had a low indirect correlation and NO and creatinine had a very low direct correlation. References Fueki H, Hino R, Yoshioka M, Nakamura M, Tokura Y.Calcinosis cutis associated with primary Sjogren9s syndrome: strong expression of osteonectin and matrix Gla protein.Rheumatology (Oxford) 2011; 50(12):2318–20. 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(9):826–31. Ahmed S, O9Neill KD, Hood AF, Evan AP, Moe SM. Calciphylaxis is associated with hyperphosphatemia and increased osteopontin expression by vascular smooth muscle cells. Am J Kidney Dis 2001;37(6):1267–76. Kawakami T, Soma Y, Mizoguchi M, Saito R. Immunohistochemical expression of transforming growth factor beta3 in calcinosis in a patient with systemic sclerosis and CREST syndrome. Br J Dermatol. 2000;143(5):1098–100. Disclosure of Interest None declared

Calcinosis in CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome can affect the spinal and paraspinal areas. We present the first case to our knowledge where a CREST syndrome patient required surgery for spinal calcinosis in both the cervical and lumbar areas. A 66-year-old female with a history of CREST syndrome presented with right-sided lower extremity radicular pain. A computed tomography (CT) scan showed bilateral lumbar masses (5.8 cm on the right, 3.8 cm on the left) that projected into the foramina and into the spinal canal. The patient underwent minimally invasive bilateral surgical resection of the paraspinal masses, posterior decompressive laminectomy, posterior interbody, and posterolateral fusion. The specimen was consistent with the calcinosis of CREST syndrome. The patient's lumbar symptoms were relieved, however, two years later she presented with right radicular arm pain. A CT scan revealed a large lobulated benign tumor-like lesion on the left at C6-C7 encroaching upon the neural foramen and a large right lobulated lesion encroaching into the neural foramen with severe compression of the neural foramen at the C7-T1 level and extension into the canal, with anterior and posterior subluxation present throughout the cervical spine. Surgery was performed, which involved cervical mass resections, posterior spinal cord decompression, reconstruction, and fusion. The patient did well and has been symptom-free since her surgery. Calcinosis of the spine is a known entity that can cause morbidity in patients with CREST syndrome. Minimal invasive surgical approaches are effective and can be considered for some of these patients.

A woman aged 23 years with a diagnosis of mixed connective tissue disorder presented with left groin pain extending over 6 months. Workup revealed avascular necrosis of the femoral head (Grade 3) secondary to systemic lupus erythematosus and chronic steroid intake. An uncemented total hip arthroplasty was considered as the patient was only in the third decade of life. During the preop workup, careful clinical assessment had revealed multiple subcutaneous nodules affecting the extensor musculature limited to the gluteal region, anterior and posterior aspects of the thigh. The diagnosis of calcinosis cutis universalis was made after a CT revealed calcified nodules in the subcutaneous, subfascial and muscular planes. A total hip arthroplasty using the posterior approach was performed with minimal trauma to the calcified nodules and thereby preventing a source of persistent drainage and reducing morbidity due to infection.

Contains fulltext : 175954.pdf (Publisher’s version ) (Open Access) To our knowledge, this is the first case report of juvenile dermatomyositis (JDM) in Tanzania. It demonstrates that the characteristic cutaneous findings of JDM may easily be overlooked, especially on dark skin, and the difficulty of clinical management in resource-constrained settings.

A 67-year-old woman with hypertension, type 2 diabetes and chronic venous insufficiency (CVI) was admitted to the emergency room due painful left leg after a fall from own height. The fall had been a true mechanical one, with no preceding dizziness, chest pain, or palpitations. On physical examination, small chronic ulcer and subcutaneous white calcifications were observed. Hemogram, electrolytes, cardiac enzymes, parathyroid hormone, calcium, phosphorus, serum creatinine and 25-hydroxycholecalciferol were unremarkable. A plain radiograph of her left leg showed no fracture and multiple radio-opaque images, clearly outlined in the subcutaneous tissues. The diagnosis of dystrophic subcutaneous calcification was made. The patient refused clinical follow-up. Calcinosis cutis (CC) is defined as the deposition of calcium salts in the skin. The condition is divided into 5 types: calciphylaxis and dystrophic, metastatic, idiopathic and iatrogenic CC. Dystrophic calcification is the most frequent type of CC. Serum calcium and phosphorus levels are normal. Local tissue damage, such as degeneration of collagen fibres, elastic fibres, fat cell necrosis caused by trauma, infections, neoplasms and many other conditions, are considered to be precipitating factors. Calcium deposits impair normal epithelial growth and cause persistent inflammation with a foreign body reaction, resulting in delayed wound healing. Dystrophic calcification is a major cause of failure of conservative ulcer management and it is considered a challenge in CVI patients.

Introduction: Idiopathic Scrotal Calcinosis (ISC) is characterized by a solitary or multiple, painless intradermal nodules in the presence of normal levels of calcium and phosphate and in the absence of any systemic metabolic disorder. Aim: To study the clinical, cytological and histopathological aspect of Idiopathic Scrotal Cutis in this geographical region and find a possible correlation between ISC and an increase in calcium compounds in the soil and water due to cement pollution in this region with many cement factories. Materials and Methods: In this study, we report twenty cases of this rare entity diagnosed over a ten year period from 2007 to 2016. A detailed history of all the patients which included age, occupation, serum calcium and phosphorus levels, FNAC and USG reports and histopathological slides was reviewed to confirm the diagnosis and study the possible pathogenesis of ISC. Results: The patient’s age ranged from 19 to 65 years with a mean of 37.2±11.4 years. The duration of swelling varied from two to 24 months, mean of 8.8±5.2 months. The most common occupation in the present study was farmers (7/20). The predominant presentation was that of scrotal swellings (17/20) and most common clinical diagnosis was sebaceous cysts (11/20). A history of white chalky discharge from the swelling was present in four cases. No metabolic disorders were noted in any patients. Solitary nodules were noted in fourteen cases which ranged from 0.5 to 3.5 cm. Histopathological examination of the nodules revealed dermal masses which were calcified and few cases were associated with a prominent foreign body reaction. All twenty cases underwent surgical excision and showed no recurrence in follow up. Conclusion: Increased levels of calcium in water could have a favourable role in the occurrence of this otherwise rare entity, inspite of normal calcium levels in the body.

Winer nodüler kalsinozis, doğumda ya da erken çocukluk çağı döneminde görülen asemptomatik, sert, sarı ya da beyaz renkte nodüler tarzda görülen, idiopatik kalsinozis kutisin bir alt formudur. Winer nodüler kalsinozis üzerinde ülserasyon gelişimi oldukça nadirdir. Ulaşılabilen Türkçe ya da İngilizce literatürde bugüne kadar Winer nodüler kalsinozis ile karişabilecek malign cilt lezyonundan bahseden benzer yazı ya da vakaya rastlanılmamıştır. Bu yazıda, sol kulak heliksinde beyaz renkte, üzeri ülsere, 3x2 mm boyutlarında nodüler lezyon şikayetiyle ailesi tarafından kliniğimize getirilen üç yaşında çocuk olgu sunuldu. Lezyonun ülsere olması, makroskobik görüntüsü ve güneş maruziyetinin en sık olduğu kulak heliksinde yerleşimi nedeniyle ön tanı olarak skuamöz hücreli karsinom düşünüldü., Winer's nodular calcinosis, presenting as an asymptomatic, firm, white, or yellow nodule at birth or during early childhood, is a form of idiopathic calcinosis cutis. Ulceration on Winer's nodular calcinosis is rarely seen. Till date, there is no report in the literature regarding the malignant skin lesion confused with Winer's nodular calcinosis. No similar case or article has been encountered in the Turkish or English literature regarding the malignant skin lesion that might be confused with Winer's nodular calcinosis. The case of a 3-year-old girl with a 3×2 mm, white, ulcerated, nodular lesion on the helix of the left ear is presented here. The lesion was thought to be a squamous cell carcinoma due to the ulceration and appearance, and it was located on the ear, which is frequently exposed to the sun.

Calcinosis cutis constitutes a heterogeneous group of chronic disorder. It can be associated with disturbance of calcium and/or phosphate metabolism (metastatic, tumor calcinosis, calciphylaxis) but may also develop without any metabolic disorder, in particular during the course of connective tissue diseases. Among these, the most common are dermatomyositis and the limited form of systemic sclerosis. The physiopathology of calcinosis cutis is poorly known. It can cause pain, chronic ulcerations, infections, which are sources of sometimes major disability. Treatment of calcinosis is challenging because no drug has been shown to be reliably effective in stopping the progression or decreasing dystrophic calcifications in controlled trials. Calcium blocker and colchicine are generally prescribed as the first line systemic therapy. In the localized forms of small lesions, surgical excision is often effective and sometimes preceded by local treatments (laser therapy, extracorporeal shock wave lithotripsy, topical sodium thiosulfate, etc.) or systemic treatment (minocycline, warfarine). When calcinosis is disseminated, it may require additional treatments (aluminium hydroxyde, bisphosphonates) possibly associated with surgery in case of large lesions. Time to response may be prolonged from weeks to months. The calcinosis cutis can lead to secondary infection, pain and functional disability that have to be prevented.

Idiopathic calcinosis cutis is a condition involving the deposition of calcium salts in the skin and subcutaneous tissue. The disease is a pathological condition of unknown origin and hence is idiopathic. The salt deposition is confined to areas such as the breast and vulva in females and scrotum and penis in males. Diffuse calcification with multiple complications in an adult is a rare entity. Only one such case has been reported in literature. A 59-year-old female presented to us with swelling of the right elbow, multiple calcific nodular lesions all over her fingers approximately 0.5x0.5 cm in size, and ulcers on her left great toe and right thumb with pain for the past two months. The ulcers were 2x2 cm and were observed to be healing without active discharge or signs of inflammation. The elbow was diffusely swollen and tender. Flexion deformity was present at the elbow. X-ray of hand and feet revealed calcinosis of the elbow and interphalangeal joints of the foot and hand. Blood tests revealed elevated C-reactive protein levels of 24 mg/dL, elevated Erythrocyte Sedimentation Rate (ESR) of 52 mm/hr., serum calcium of 9.7 mg/dL and a serum phosphorous of 5 mg/dL. Cultures from the foot ulcer were positive for methicillin-resistant staphylococcus aureus (MRSA). Workup for collagen vascular disease was negative. Histopathology confirmed calcinosis cutis. Treatment involved a conservative approach, including physiotherapy for the flexion deformity, antibiotics for MRSA, analgesics for pain relief and daily dressings. This case demonstrates that if a patient presents with multiple chalky nodular lesions with or without ulceration, pain and discharge involving areas of the upper limb or lower limb, diagnosis of idiopathic calcinosis cutis could be considered as a differential, despite its common confinement to the scrotum, breast, vulva and penis.

A 61-year-old female received intravenous injection of calcium chloride after common iliac artery bypass surgery. A red flare appeared at the site of the intravenous infusion on the left forearm and gradually progressed to induration. Seven weeks later, she was referred to the Department of Dermatology for management. Physical examination showed an indurated plaque measuring 13 × 65 mm in size, with linearly distributed ulcers covered by yellowish-white substance, surrounded by reddish skin. Laboratory tests showed no significant abnormalities including serum calcium, phosphate and thyroid hormones. Cultures were negative for microorganisms. Histopathological examination showed calcium deposition confined to the dermis. The lesion healed spontaneously within 2 months with scar formation. A review of the Japanese literature showed confinement of calcium deposits to the dermis in most of the reported cases. We speculate that the pathomechanism of dermal calcinosis includes needle-induced tissue injury with capillary destruction, leading to release of excess calcium between collagen fibers, and its binding to phosphate in the dermis and deposition as calcium phosphate crystals.

Purpose To evaluate the functional outcome after removal of digital calcinosis cutis in patients with scleroderma using a high-speed burr. Methods A retrospective analysis was performed of 9 consecutively enrolled scleroderma patients who underwent surgery by the senior author. A debulking procedure using a high-speed micro-burr to soften and express calcific material in digits was performed. Demographics, complications, recurrence, and postoperative functional outcome measurements including the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Michigan Hand Questionnaire, a study-specific questionnaire, a visual analog scale, and the Short Form-12 were collected. Results Mean follow-up time was 2 years. Four of 9 patients were very or somewhat satisfied with the procedure. Eight complications were recorded in 6 patients, including weakness, decreased motion, numbness, and superficial wound infection. The mean Disabilities of the Arm, Shoulder, and Hand score in patients who would have surgery again was 27 (4 of 9), versus 54 (5 of 9) for those who would not. Two patients had no recurrence. There were 7 cases of recurrence; 3 patients had late recurrence to a small degree, 3 had early complete recurrence, and 1 had recurrence at an unknown onset. No patient reported complete resolution of calcinosis. Patient satisfaction appeared inversely correlated to the number of digits involved. Conclusions Patients with discrete areas of calcinosis cutis, including those with 1 or 2 digits affected, did much better than patients with diffuse disease and multiple affected digits. Patients should be counseled that the benefit might be more limited than previously reported, and recurrence is likely. Type of study/level of evidence Therapeutic IV.

Iatrogenic calcinosis cutis is a rare disorder that can be due to the intravenous administration of calcium or phosphate-containing infusions such as calcium gluconate or calcium chloride with extravasation. Fortunately, the course of calcinosis cutis is benign in immunocompetent children. The treatment remains supportive therapy. After about 6 months, there is no evidence of tissue calcification. We describe a 4-year-old girl with Acute Lymphoblastic Leukemia (ALL) who developed severe calcinosis cutis in the left humerus after extravasation of calcium gluconate during the treatment for the tumor-lysissyndrome-related hypocalcaemia. Surgical debridement and local wound care were not successful, and so a temporary suspension of chemotherapy was necessary to achieve complete healing of the lesion. Notwithstanding this complication, her ALL is in complete hematological remission after 8 months from the diagnosis. No functional or sensitive impairment due to the cutis has persisted.