Diagnosis Of Calcinosis Cutis Research Articles

33641 Treatments of calcinosis cutis in autoimmune connective tissue diseases

Calcinosis cutis is often seen in the setting of autoimmune connective tissue disease (ACTD). Treatment for calcinosis cutis is often difficult and unsuccessful. We sought to evaluate outcomes at our institution of treatments for calcinosis cutis. A search in the patient data registry was conducted to select patients with the diagnosis of calcinosis cutis and ACTD at Massachusetts General Hospital and Brigham Women’s Hospital. Out of 220 charts, 43 patients were identified with adequate documentation to assess outcomes and the diagnosis of calcinosis cutis in provider notes with underlying ACTD. 86.0% of patients had some form of medical intervention and 39.5% of patients underwent surgical excision. 44.2% of patients had no response or resolution of their calcinosis in response to treatments. 39.5% of patients indicated partial resolution of calcinosis cutis. Only 25% of patients with a documented partial response was due to medical therapy. There was often no physical examination documentation from the provider demonstrating a reduction from the previous examination. In our case-series we found that results are few and far between. Complete resolution was only seen through surgical excision of nodules or through the use of sodium thiosulfate on small lesions (<3 mm). Additionally, many of the patients that were categorized as a partial reduction was largely due to self-reported improvement. In future, accurate documentation of calcinosis lesion sizes and locations by text or photographs would provide more rigorous data, rather than depending on patient self-reported improvement, which could be influenced by a placebo effect.

14409 Successful treatment of calcinosis cutis of fingertip in the setting of CREST syndrome with topical 20% sodium thiosulfate

A 67-year-old woman with a 20-year history of limited scleroderma (CREST syndrome), presented to our clinic with a 6-month history of a painful and ulcerated lesion on the tip of the right index finger. Dermatologic examination revealed a 3×3 mm ulcer with extrusion of a little stony hard white material associated with significant tenderness. The diagnosis of calcinosis cutis (CC) was made. In this patient, antinuclear antibody and anticentromere antibody were positive while anti-topoisomerase I (anti–Scl-70) antibody was negative.

FNAC of Bilateral Iliac Idiopathic Calcinosis Cutis: A Rare Case Report

We report a case of idiopathic calcinosis cutis diagnosed by fine needle aspiration cytology in a 70 year old female who presented with subcutaneous swellings near the bilateral iliac crests. Cytological finding of amorphous calcium salts with histiocytes and the appropriate clinical background led to the cytodiagnosis of idiopathic calcinosis cutis as subsequently confirmed on histopathology. Pitfalls in the diagnosis of calcinosis cutis on cytology smears are also discussed

Plain radiography is effective for the detection of calcinosis cutis occurring in association with autoimmune connective tissue disease

Studies on the radiological findings of calcinosis cutis in patients with autoimmune connective tissue disease (ACTD) are limited. To describe imaging findings and radiological patterns of calcinosis cutis occurring with ACTD. We retrospectively reviewed the cases of 37 patients with imaging studies assessing for calcinosis cutis associated with ACTD at our institution between 1996 and 2009. A formal blinded review of available images (i.e. radiographs, computed tomography scans) for all 37 patients was performed by radiologists. Of 37 patients, 30 (81%) were female. The mean age at diagnosis of calcinosis cutis was 43·4years. Patients had the following ACTDs: dermatomyositis (n=17) with classic (n=9), juvenile (n=7) and amyopathic (n=1) subtypes; systemic sclerosis with limited cutaneous scleroderma (n=8); undifferentiated connective tissue disease (n=4); mixed connective tissue disease (n=3); systemic lupus erythematosus (n=2); lupus panniculitis (n=1); overlap connective tissue disease (n=1); and polymyositis (n=1). Plain radiographs detected calcinosis in all 37 patients; a nodular pattern of calcification was most commonly observed (31/37; 84%). Two or more morphological patterns of calcification were present in 19 patients (51%). In general, individual patterns were not specific to a particular ACTD subtype. Radiography detected calcinosis in all patients and is recommended for initial imaging of calcinosis. Multiple morphological patterns of calcification were observed across ACTD subtypes. Further studies should correlate radiological studies with treatment of calcinosis and underlying ACTD.

Biochemical and molecular aspects of spectral diagnosis in calcinosis cutis

Calcinosis cutis (CC) is a type of calcinosis wherein insoluble compounds or salts deposited on the skin. Clinical diagnosis of CC is usually achieved through time consuming histopathological or immunohistochemical procedures, but it can only be empirically identified by experienced practitioners. The use of advanced vibrational spectroscopy has been recently shown to have great potential as a diagnostic technique for various diseased tissues because it analyses the chemical composition of diseased tissue rather than its anatomy and predicts disease progression. This review article includes a summary of the application of Fourier transform infrared (FT-IR) and Raman spectroscopic or microspectroscopic analysis for the rapid diagnosis and identification of the chemical composition of skin calcified deposits in patients with various CC symptoms. Both advanced techniques not only can detect the types of insoluble salts such as calcium phosphate, calcium carbonate, and monosodium urate, and β-carotene in the calcified deposits of human skin tissue but also can directly differentiate the carbonate substitution in the apatite structure of the skin calcified deposits. In particular, the combination of both vibrational techniques may provide complementary information to simultaneously assess the intact components of the calcified deposits. In the future, both FT-IR and Raman vibrational microspectroscopic techniques will become available tools to support the standard test techniques currently used in some clinical diagnoses. Molecular spectroscopy technique is rapidly changing disease diagnosis and management.

Idiopathic calcinosis cutis of nasal dorsum

A 23-year-old lady presented with a slowly progressing firm mass on the nasal dorsum since 8 months. Her biochemical, haematological and collagen vascular disease screening tests were normal. Radiographs of the nasal bones showed a subcutaneous calcifying lesion with no evidence of nasal bone erosion. A diagnosis of idiopathic calcinosis cutis (ICC) was made. The mass was excised and soft tissue defect was augmented with silicone prosthesis. The histopathology with the haematoxylin and eosin staining and von Kossa stain confirmed the diagnosis of calcinosis cutis. This is an unusual presentation of ICC involving the nasal dorsum requiring surgery and nasal dorsal augmentation with silicone prosthesis.