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Metastatic
calcification This occurs as a result of
hypercalcemia or hyperphosphatemia and is found in the kidney,
stomach, lung, brain, eyes, skin, subcutaneous and joint
tissues, and arterial walls. This type of calcinosis is usually
related to other underlying conditions, such as
hyperparathyroidism, hypoparathyroidism or renal disease.
Patients with metastatic calcification most frequently have a
history of chronic renal failure.
Tumoral calcinosis The cause
of this rare condition is not known. This condition is
characterized by the rapid development of large, globular
calcifications in the subcutaneous tissue and muscles
surrounding the hips, shoulders, elbows, hands, and chest walls.
One theory for its cause states that this condition is
hereditary and is associated with hyperphosphatemia.
Idiopathic calcinosis This
condition occurs in the absence of any known tissue injury or
systemic metabolic defect. Calcification is localized to one
general area.
Iatrogenic calcinosis This
condition arises as result of a treatment or procedure, for
example, through administration of calcium or phosphate
intravenously, or calcium deposition in newborns from repeated
heel sticks.
Symptoms
The symptoms of calcinosis vary depending on its underlying
cause. The first sign is the formation of lesion but it is often
symptomless. The lesions are usually firm, whitish/yellowish
nodules appearing on the surface of the skin. It could either be
a single lesion though multiple lesions are more common. Over
time the lesions become tender and ulcerate, discharging
chalk-like creamy material consisting mainly of calcium
phosphate with a small amount of calcium carbonate. Lesion
around the fingertips may be painful, while lesions at other
sites may restrict joint mobility due to stiffening of the skin.
Cutaneous gangrene may occur in severe cases.
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Diagnosis
To detect any metabolic imbalances resulting in elevated calcium
and phosphate levels, laboratory tests are performed. Plain film
x-ray, CT scanning and bone scintigraphy are useful tools to
understand the extent of tissue calcification. Biopsy of
cutaneous lesions is used to confirm diagnosis.
Treatment
The treatment of calcinosis should look into the underlying
cause of calcinosis cutis and treated accordingly. Medications
may be used to help relieve symptoms of the condition:
• Corticosteroids
• Probenecid
• Colchicine
• Sodium Etidronate
• Diphosphonates
• Diltiazem
• Magnesium
• Aluminium antacids
• Oral low-dose anti-coagulant therapy
Surgical removal of lesions is indicated when they become very
painful, ulcerate and cause functional impairment. Recurrence is
common after excision and new deposits may appear around other
joints.
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