Calcinosis

Calcinosis refers to the deposition of insoluble calcium salts in soft tissues, most commonly in the skin and subcutaneous tissues. It can present as hard nodules, plaques, or masses that may ulcerate or become infected, and it can occur in isolation or as part of an underlying systemic condition.

Classification

- Dystrophic calcinosis: calcium deposits in damaged or devitalized tissue with normal serum calcium and phosphate levels; the most common form, often associated with connective tissue diseases such as systemic sclerosis, dermatomyositis, or local trauma.

- Metastatic calcinosis: calcium salts deposit in normal tissues due to elevated blood calcium or phosphate (hypercalcemia or hyperphosphatemia), seen with disorders such as endocrine abnormalities or advanced renal failure.

- Iatrogenic calcinosis: results from medical procedures or administration of calcium-containing substances.

- Idiopathic calcinosis: occurs without an identifiable underlying metabolic disorder or tissue damage.

- Tumoral calcinosis: large periarticular calcified masses, frequently near joints; can be familial and related to phosphate metabolism disorders.

Clinical features

Calcinosis can produce firm, sometimes painful nodules or plaques. Lesions near joints or in digits may limit movement and occasionally ulcerate or become infected. Symptoms depend on size, location, and any secondary complication, such as infection or ulceration.

Diagnosis

Diagnosis combines clinical history with imaging and laboratory tests. X-rays or CT scans reveal calcified deposits; MRI can define extent and relation to surrounding structures. Blood tests assess calcium, phosphate, parathyroid hormone, renal function, and, when appropriate, autoimmune serologies to identify associated diseases.

Management

Treatment is guided by type and underlying conditions. Addressing the root cause is important (for example, managing hypercalcemia or renal failure, controlling autoimmune disease). Local measures include wound care and infection control. Localized, symptomatic lesions may be treated with surgical excision. In certain cases, medical therapies aiming to regulate mineral metabolism or reduce lesion burden may be used, and phosphate management is considered in tumoral calcinosis. Recurrence can occur, especially if the underlying disorder is not controlled.

Prognosis

The course varies; some lesions remain stable for years, while others progress or recur after treatment. Management focuses on symptom relief, functional preservation, and treating any associated conditions.