Calcinosis cutis

Wheeland, R.G. and Roundtree, J.M., Calcinosis cutis resulting from percutaneous penetration and deposition of calcium, /. Am. Acad. Dermatol. 12, 172-175, 1985. 

Johnson, R.C., Fitzpatrick, J.E., and Hahn, D.E., Calcinosis cutis following electromyographic examination, Cutis 52,161-164, 1993. 

The local adverse effects of topical glucocorticoids (1,2) are listed in Table 1. They include transient local erythema, calcinosis cutis, cramps (due to injection of crystals into a vessel), amaurosis (a dubious report), depigmentation, skin atrophy, and skin necrosis (3,4). The systemic adverse effects of topical glucocorticoids (5-8), which are those to be expected from systemic use, are also listed in Table 1. 

Two renal transplant recipients developed calcinosis cutis (tender erythematous subcutaneous nodules with induration, ulceration, and necrosis), confirmed by bone scan and biopsies, at the site of subcutaneous administration of nadroparin (72). Both had secondary hyperparathyroidism and a raised calcium-phosphate product at the time of administration. The authors suggested that the high concentration of calcium in nadroparin (220 mmol/1) had been an important factor, since in the same patients subcutaneous injections of nicomorphine or dalteparin did not cause subcutaneous nodules. Three more cases were found after retrospective examination of all 51 adult patients who underwent a renal transplantation in the same hospital during 7 months, and there were no other cases of calcinosis cutis at the injection sites of low molecular weight heparins after nadroparin was replaced by dalteparin. 

Extraskeletal calcification occurs in several conditions unrelated to demonstrable abnormalities of calcium metabolism, such as scleroderma, myositis ossificans, calcinosis universalis, calcinosis cutis, and local tissue damage in the kidney. These disorders are not usually associated with changes in serum alkaline phosphatase (B30). Elevated values have, however, been reported in paraplegic patients with ectopic bone formation (F23), and a positive correlation has been demonstrated between the activity of serum alkaline phosphatase and the progression of this disorder. Nicholas (N4) claimed that hyperphosphatasemia in such a situation may help to differentiate thrombophlebitis, septic arthritis, and cellulitis from ectopic bone formation. 

Alizarin can be used to stain calcium deposits in soft tissues. Dermato-pathologists use it to detect dermal calcium in disorders such as pseudoxanthoma elasticum and calcinosis cutis [147]. It harmlessly stains also living tissues. Bones of animals that ate madder turned pink or red. The active compound responsible for the staining is supposed to be pseudopurpurin [147]. 

Cheng PS, Lai FJ. Sporotrichoid-like calcinosis cutis and calcifications in vessel walls and eccrine sweat glands foUowing intravenous infusion of calcium gluconate. Br J Dermatol 2012 166(4) 892-4. 

Bonnecarr re L, TempUer 1, Carron PL, Maurizi J, Salameire D, Beard JC, et al. Calcrnose cutanee et sous-cutanee apres itq ection dTieparine calcique a propos de deux cas. Two cases of iatrogenic cutis and subcutis calcinosis after calcium-containing heparin itq ection. J Mai Vase 2009 34(5) 366-71. 

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