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Calcinosis & Scleroderma: Complications and Treatments

Calcinosis is the abnormal collection of calcium salts which form under the skin and in muscles or tendons. Calcinosis in scleroderma (also called calcinosis cutis) can develop slowly over time and have no other symptoms or can come on suddenly and be severe. It affects about 25% of people with systemic sclerosis (1).

Common Symptoms of Calcinosis in Scleroderma

Calcinosis in scleroderma appears as hard, irregular nodules in or under the skin in any area of the body. These deposits vary in size and shape, ranging from a tiny speck, pea-sized, to larger tumorous deposits located most commonly in the fat pad of the fingertips, as well as on the hands, arms, elbows, knees, and trunk. They may also develop in the shoulders.

They can also break the surface of the skin, becoming a lesion and can be skin-colored or white, hard or soft. Some calcinosis nodules might leak a white fluid and in severe cases can be very painful and limit range of motion.

Calcinosis can also lead to complications such as ulceration, infection, joint contractures, or pressure on nearby nerves.

Treatments for Calcinosis in Scleroderma

Treatment of calcinosis from scleroderma can be challenging. There is no treatment that is effective for everyone, and few medications or treatments are effective against calcinosis.

Increasing blood flow to the extremities, through smoking cessation, decreasing stress, and limiting exposure to cold, may be helpful in preventing calcinosis symptoms. Appropriate sun-protection is always important since sun exposure can stimulate the immune system, which may contribute to calcinosis.

Calcinosis lesions may respond to the following medication aimed to decrease calcium in the tissues:

  • Antacids can reduce risk by helping to prevent the absorption of phosphate
  • Bisphosphonates help hinder bone turnover and lower calcium and phosphate levels
  • Calcium channel-blockers can diminish the concentration of calcium in the cells.

Surgical excision may be used to remove smaller lesions that are confined to a single area, especially those in painful or troubling areas of the body. Unfortunately, there is always a risk that the lesions will return. Calcinosis in scleroderma occasionally clears on its own with no intervention. There is still much to learn about calcinosis, its treatment, and its prevention.

Sources:
  1. Allanore Y, Simms R, Distler O, et al., Nat Rev Dis Primers. 2015;1.doi:10.1038/nrdp.2015.