Calcinosis

Calcinosis cutis is the deposition of insoluble calcium in the skin and subcutaneous tissues. It is associated with autoimmune connective tissue diseases (ACTDs) including systemic sclerosis (SSc). Calcinosis in SSc has been associated with longer disease duration, digital ischemia, and positive anti-PM/Scl antibody. Calcinosis in SSc presents as subcutaneous nodules or lumps of variable size and shape, often at sites of recurrent microtrauma. The most frequent body site involved in SSc is the hands (particularly the fingers). Calcinosis is responsible for a high burden of disability in patients with SSc. If the clinical presentation does not allow a definite diagnosis, plain radiography can confirm the diagnosis. More experimental diagnostic studies include ultrasonography, various computed tomography modalities, and magnetic resonance imaging. Several pharmacologic therapies have been tried for calcinosis in case reports/case series with variable results. Particularly, minocycline and topical or intralesional sodium thiosulfate might be helpful, but future randomized controlled clinical trials using validated outcome measures are needed. Surgical excision of calcium deposits remains the mainstay of treatment.