Calcification Of Skin And Subcut Tissue Flashcards
Dystrophic calcification secondary to inflammatory disease/infections (Calcinosis cutis)
No disturbance of systemic calcium homeostasis
Presents many years after onset of underlying disease
ASSOCIATIONS AICTD - - Dermatomyositis - LE esp lupus panniculitis (asymptomatic) - Scleroderma esp CREST (calcinosis, Raynaud’s phenomenon, esophageal dysfunction, sclerodactyly, telengiectasia) - Morphea - Lichen sclerosus Overlap CTD - - RA - Polymyositis Other inflammatory diseases - - PCT - Pancreatic panniculitis - complication of chronic leg ulcers —> impair healing - Subcutaneous fat necrosis of the newborn Infections - - Onchocerciasis - Cysticercosis
CLINICAL FEATURES DERMATOMYOSITIS Yellow white nodules, plaques Trunk, limbs Ulcerate Discharge chalky material \+/- calcification underlying muscle —> contracture —> deformity
CLINICAL FEATURES SLE Asymptomatic Nodules subcut tissue buttocks Sites of LE skin involvement Also in other types of LE i.e. SCLE, discoid lupus, lupus panniculitis
CLINICAL FEATURES CREST SYNDROME Nodules, plaques Ulcerate Extrude chalky material Sites of trauma esp elbows, knuckles, volar fingers
CLINICAL FEATURES PCT Esp when assoc with pseudoscleroderma Ulceratinng plaques Exude chalky material Head, neck, dorsum hands Heals with scarring Alopecia to scalp
CLINICAL FEATURES IN INFECTIONS (Onchocerciasis, Cysticercosis)
Calcified nodules on head, chest, pelvis
COMPLICATIONS
ulceration
Secondary infection
When widespread —> contracture, deformity
COURSE/PROGNOSIS
Rarely regresses if untreated
IX calcium homeostasis Serum Ca, PO4 LFT, mainly for ALP Vit D PTH \+/- XRay if diagnostic uncertainty And/or skin biopsy of diagnostic uncertainty
IX AICTD
HISTO
Calcium deposits (fine granules ind ermis, large irregular masses in subcutis) -
- blue with H&E stain
- black with von Kossa stain
Dermatomyositis, CREST —> Transepidermal elimination of calcium
Pamcreatic panniculitis —> calcification within cytoplasm of ghost cells
MX - difficult Surgical excision (symptomatic Localised disease) Rx of choice
TOPICALS
Topical 10% sodium thiosulphate solution 2x/week
INTRALESIONAL
ILCS 20mg/mL every 4-8 weeks
IL 25% sodium thiosulphate solution - use 0.1ml
PHYSICAL
CO2 ablative laser
Stem cell transplant
SYSTEMIC Diltiazem up to 480mg/d Bisphosphonates - - PO Alendronate 10mg/d - PO Etidronate 800mg/d - IV Palmidronste 1mg/kg/d for 3 days every 3 months Aluminium hydroxide Minocycline Ceftriaxone Colchicine Probenecid Warfarin IVIg
Dystrophic calcification secondary to trauma or injection/infusion of calcium containing materials
CLINICAL EXAMPLES
Heel calcinosis after heel prick testing in infants
Calcification of burns
Calcification of keloid scars after abdo surgery
Calcification d/t leakage of calcium containing injections/infusions i.e. heparin/LMWH more common in setting of renal patients with abnormal calcium homeostasis —> inflammation —> cell death —> calcification
CLINICAL FEATURES
Hx of trauma
Hx of recent infusion/injection
Can take months/years to develop
HEEL PRICK CALCINOSIS
Firm papule on the heel
Symptomatic if persists esp when infant starts to wear shoes
May resolve without Rx
Excision for persistent symptomatic lesions
POST INFUSION/INJECTION CALCIUM CONTAINING MATERIALS
Warm tender swelling at site of injection
Days to weeks
Ulceration —> necrosis
Resolves omce heparin stopped
Surgical excision may be needed
IX fpr calcium homeostasis Serum Ca, PO4 ALP Vit D PTH \+/- XRay if diagnostic uncertainty And/or skin biopsy of diagnostic uncertainty
MX
Local wound care of ulcerated areas
Excision for persistent symptomatic lesions
HISTO Dermal collection of calcium Variable inflammatory infiltrate Overlying acanthosis Hyperkeratosis Transepidermal elimination Calcium around collagen budndle (if leakage of IV solutions)
