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| Calcinosis Cutis, Causes, Diagnosis, Treatment, Prevention, Complications |
Calcinosis cutis is a condition caused by a buildup of calcium in the skin. This disorder can be caused by an autoimmune disease, kidney disease, or a side effect of medication.
Calcium is an essential mineral for the body. Besides being useful for maintaining healthy teeth and bones, calcium also plays a role in the blood clotting process, and helps maintain muscle and nerve function.
Calcinosis cutis can affect anyone, both in people who have high and normal calcium levels.
Causes of Calcinosis Cutis
The causes of calcinosis cutis are very diverse, depending on the type. Here is the explanation:
Dystrophic calcification
Dystrophic calcification occurs when damage to skin tissue triggers the release of proteins that bind calcium and phosphate. As a result, calcium accumulates in the skin.
Dystrophic calcifications can be caused by various diseases, such as:
- Scleroderma
- Lupus
- Dermatomyositis
- Rheumatoid arthritis
- Skin infection or extensive burns
Metastatic calcification
Metastatic calcification occurs when the levels of calcium and phosphate in the body are too high, but there is no tissue damage. These high levels of calcium and phosphate lead to the formation of bumps on the skin.
Causes of metastatic calcification include:
- Chronic kidney failure
- Hyperparathyroidism
- Excess vitamin D
- Bone disease, eg Paget's disease
- Sarcoidosis
- Milk-alkali syndrome, due to eating too many foods high in calcium
Iatrogenic calcification
Iatrogenic calcifications are caused by the side effects of certain medications or medical procedures. These medications or medical procedures include:
- Infusion fluids containing calcium and phosphate
- Injections of calcium gluconate, calcium chloride, or para-aminosalicylic acid for the treatment of tuberculosis (TB)
- Heel stick procedure or blood sampling from a newborn's heel
Idiopathic calcification
People with this type of calcification do not have a specific disease that underlies the accumulation of calcium, so they are called idiopathic. Idiopathic calcifications commonly occur in children and adolescents.
calciphylaxis
As with idiopathic calcifications, the cause of calcification is also unknown. However, calcification is thought to occur due to the following conditions:
- Excess body weight (obesity)
- Diabetes
- Hyperparathyroidism
- Chronic kidney failure
Symptoms of Calcinosis Cutis
Calcinosis cutis is characterized by hard, yellowish-white bumps on the surface of the skin. Calcinosis cutis lumps develop gradually and vary in size. In some cases, the lump can cause itching and pain.
Although rare, calcinosis cutis can develop into blisters that don't heal and cause tissue death (gangrene).
Based on the type of calcinosis cutis, lumps can also develop in all parts of the body, including the bones, lungs, kidneys, blood vessels, and reproductive organs.
When to go to the doctor
Do an examination to the doctor if a lump appears on the skin that is hard textured and yellowish white in color. Examination needs to be done to find out the cause of the lump and get the right treatment.
Diagnosis of Calcinosis Cutis
To diagnose calcinosis cutis, the doctor will ask the patient's symptoms and medical history, followed by a complete physical examination.
Furthermore, the doctor will perform a number of follow-up examinations below to confirm the diagnosis:
- Blood tests, to measure calcium and phosphate levels
- Scanning with X-rays or CT scans, to measure the level of calcium that has accumulated in the internal organs
- Biopsy by examining skin samples, to determine the presence or absence of abnormal tissue
- Kidney function tests, to check for kidney disease
- Test for vitamin D levels, to find out whether vitamin D levels are more or less
- Parathyroid and thyroid hormone tests, to detect hyperparathyroidism
- SCL-70 antibody test, to diagnose scleroderma
- 24-hour urine test, to measure calcium levels in urine
Calcinosis Cutis Treatment
Treatment for people with calcinosis cutis depends on the cause and severity. Treatment methods include:
Drugs
Medications that doctors can prescribe to treat calcinosis cutis include:
- Warfarin, to normalize vitamin K levels in some patients with calcinosis cutis
- Diltilazem, to decrease the supply of calcium to damaged tissues
- Bisphosphonates, to reduce the turnover and absorption of calcium in the body
- Minocycline or ceftriaxone, to bind calcium and reduce inflammation
- Aluminum hydroxide, to treat calcinosis cutis in patients with lupus and dermatomyositis
- Probenecid, to increase the excretion of phosphate through the urine
Operation
Surgical removal of the lump can be performed if the lump is accompanied by pain and blisters, recurrent infection, or causes organ dysfunction.
Keep in mind, surgical scars can also trigger a buildup of calcium. Therefore, the doctor will perform surgery by removing a small portion of the lump first.
Other therapies
Calcinosis cutis can also be treated with laser therapy and iontophoresis. Laser therapy aims to dissolve calcium deposits using a carbon dioxide laser beam. While iontophoresis is done to break down calcium by using a weak electric current.
Calcinosis Cutis Complications
Calcinosis cutis can cause a number of complications at the site of the growth of the lump. These complications include:
- Limited body movement
- Pain and numbness
- Network death
- Bacterial infection
- Kidney stones
- Heart valve damage
Calcinosis Cutis Prevention
Calcinosis cutis is not always preventable. However, there are several efforts that can be done to prevent the buildup of calcium in the body, including:
- Have regular blood tests to measure calcium levels for people over 65 years old
- Check with your doctor regularly if you are born with abnormalities in the heart or kidneys
- Consult a doctor during treatment that can affect calcium levels, such as taking medication to treat cholesterol and hormone replacement therapy
- Limit intake of high-calcium supplements and consult a doctor about the appropriate amount of calcium intake based on age, gender, and health condition
- Implementing a healthy lifestyle, for example fulfilling a balanced nutritional intake, quitting smoking, and not consuming alcoholic beverages
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