Systemic sclerosis (or scleroderma) is characterized by many skin changes, including calcinosis. In this article, we will discuss what is calcinosis, how it is diagnosed and available treatments.

WHAT IS CALCINOSIS?

Calcinosis is an accumulation of calcium in the skin and surrounding tissues. It can affect up to 20-40% of people with scleroderma, with a similar rate between limited and diffuse scleroderma. It often occurs on the hands, forearms, elbows, and knees, despite normal calcium levels in the blood. Small lesions may go unnoticed, but may also cause pain, interfere with joint function, or be complicated by ulcers, infections, or nerve compression. Unfortunately, few cases of calcinosis improve spontaneously with time, with most lesions remaining stable or worsening after 1 year.

Finally, neem oil with Hypericum plant extract is an herbal therapy that is often used in wound care. A pilot study of 21 scleroderma patients with open calcinotic wounds followed over 40 days found that neem oil helped complete healing in 45% of patients, perhaps by softening and facilitating excision of calcium deposits. This would need to be further supported in larger studies.

Interventions

Surgery to remove calcinosis can be an effective treatment and is considered for lesions that are affecting hand or joint function, compressing a nerve, or causing severe discomfort. Complications include recurrence in 15%, delayed wound healing in 13%, and wound infection in 10% of cases. Extracorporeal shockwave therapy uses acoustic shock waves to break apart and destroy calcinosis. It is performed by physiotherapists who have received the appropriate training. It can help relieve pain associated with calcinotic lesions that are not amenable to surgery. Several prospective studies have found improvements in pain and size of calcinotic lesions. It often involves 3 to 5 sessions done every 7 to 10 days.

In Summary

Calcinosis is a feature of scleroderma that is common but unfortunately difficult to treat. Important preventative measures include avoiding trauma and ensuring good blood circulation such as through smoking cessation, cold avoidance, proper management of Raynaud, and treating ulcers. For calcinotic lesions that are symptomatic, topical or injected sodium thiosulfate may be helpful. Surgery may be considered for lesions that significantly affect function and quality of life. More research is needed to understand the cause and optimal treatment of calcinosis.

REFERENCES:

1. Nowaczyk J, Zawistowski M, Fiedor P. Local, non-systemic, and minimally invasive therapies for calcinosis cutis: a systematic review. Arch Dermatol Res 2022;314(6):515-25. doi: 10.1007/s00403-021-02264-5 [published Online First: 20210624]
2. Elahmar H, Feldman BM, Johnson SR. Management of Calcinosis Cutis in Rheumatic Diseases. J Rheumatol 2022;49(9):980-89. doi: 10.3899/jrheum.211393 [published Online First: 20220515]
3. Davuluri S, Lood C, Chung L. Calcinosis in systemic sclerosis. Curr Opin Rheumatol 2022;34(6):319-27. doi: 10.1097/ bor.0000000000000896 [published Online First: 20220819]

April 2024