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Calcinosis Cutis and Calcinosis Circumscripta 140.e5

ASSOCIATED DISORDERS Dystrophic calcification probably involves Surgical excision is curative for solitary lesions
Calcinosis cutis: abnormally high mitochondrial calcium/ of calcinosis circumscripta.
VetBooks.ir • Rarely, hypertrophic osteodystrophy, chronic and cell death. Calcium salts are deposited along Acute General Treatment Diseases and Disorders
phosphate levels, resulting in crystal formation
• Iatrogenic hyperglucocorticism or endog-
enous HAC
• Discontinue systemic glucocorticoids as soon
collagen and elastin fibers.
as possible.
kidney disease
Clinical Presentation DIAGNOSIS • Oral antihistamines and bathing with
chlorhexidine-based shampoo may be effec-
DISEASE FORMS/SUBTYPES Diagnostic Overview tive in controlling pruritus and secondary
Calcinosis cutis is classified as dystrophic, The diagnosis is suspected from the history infection often associated with calcinosis
metastatic, idiopathic, or iatrogenic. and clinical presentation. Histopathology can cutis.
• Dystrophic calcification develops secondary to confirm the diagnosis.
local tissue damage in dogs with iatrogenic Chronic Treatment
hyperglucocorticism or endogenous HAC. Differential Diagnosis Applications of medicinal grade dimethyl
Reported in association with systemic disease • Calcinosis cutis: bacterial pyoderma, deep sulfoxide (DMSO) gel q 24h may aid in dis-
(leptospirosis) or diseases associated with fungal infection, demodicosis, neoplasia solving calcium deposited in calcinosis lesions
chronic inflammation in the skin. • Calcinosis circumscripta: neoplasia, foreign and hasten resolution of clinical lesions. If
• Metastatic calcification denotes precipitation body lesions are extensive or found on multiple body
of calcium salts in normal tissues as a con- regions, only one-third of all lesions should
sequence of systemic imbalances of calcium Initial Database be treated each day. Rotating among affected
and phosphorous (e.g., chronic kidney • Cytologic evaluation of exudates: amorphous, lesions will prevent possible hypercalcemia
disease). gritty material associated with rapid dissolution of calcium
• Idiopathic calcification develops without • Skin scrapings: sample has gritty consistency into systemic circulation. Treatment may be
identifiable tissue injury or metabolic • Routine CBC and serum biochemical profile: required for several months.
abnormalities. Can develop in puppies after often changes associated with HAC (p. 485)
systemic disease or spontaneously appear and PROGNOSIS & OUTCOME
resolve by 1 year of age. Reported in dogs Advanced or Confirmatory Testing
with systemic blastomycosis. • Histopathologic assessment of skin biop- • Calcinosis cutis may regress spontaneously
• Iatrogenic calcification occurs secondary to sies: multifocal accumulations of granular over weeks to months after resolution or
percutaneous absorption or subcutaneous amorphous basophilic debris in deep dermal control of the underlying disease. Unless
administration of calcium-containing or subcutaneous tissue encompassed by all glucocorticoids are discontinued, it is
products. granulomatous inflammation unlikely that calcinosis cutis lesions will
• Radiographs: conglomerated calcified mass in resolve.
HISTORY, CHIEF COMPLAINT skin or subcutis with calcinosis circumscripta • Recurrence of calcinosis circumscripta lesions
• Dogs with calcinosis cutis may present with • Additional testing may be appropriate to after surgical excision does not occur.
erythematous papules and ulcerated plaques confirm associated or causative disorders
with gritty surfaces, with or without concur- (e.g., low-dose dexamethasone suppression PEARLS & CONSIDERATIONS
rent pruritus. test).
• In calcinosis circumscripta, dogs present with Comments
a solitary mass over bony prominences or in TREATMENT In patients with calcinosis cutis associated
the oral cavity, particularly the tongue. with excessive glucocorticoids, lesions increase
Treatment Overview in size, or new lesions may appear for up to
PHYSICAL EXAM FINDINGS In most patients with calcinosis cutis, 3 months after discontinuing systemic or
• Calcinosis cutis lesions may be found lesions slowly resolve spontaneously once the topical glucocorticoids or starting treatment
anywhere on the body but typically develop underlying disease is controlled or resolved. of endogenous HAC.
along the dorsum of the trunk, especially
the dorsal cervical area, inguinal region, and
axillae. Early lesions are erythematous papules
that coalesce to form firm, gritty plaques. A
chalky white to pink material can be seen
through the skin of early nonulcerated
lesions. Ulceration and crusting occur during
transepidermal elimination of mineralized
debris. Lesions can be quite pruritic, leading
to extreme self-trauma.
• Calcinosis circumscripta is commonly a
solitary lesion, but multiple masses are pos-
sible. The lesion is a firm, haired to alopecic,
well-circumscribed, subcutaneous or deep
dermal mass that may ulcerate and discharge
a chalky or gritty substance. Lesions are seen
over bony prominences, especially the lateral
metatarsal and phalangeal areas of the hind
limbs, or on the tongue.
Etiology and Pathophysiology
The pathogenesis of calcinosis cutis and cal- CALCINOSIS CUTIS AND CALCINOSIS CIRCUMSCRIPTA Calcinosis cutis. Note the crusted, erythematous
cinosis circumscripta is not fully understood. papules. (Courtesy Dr. Jocelyn Wellington.)

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