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TEACHING IMAGE
Year : 2017  |  Volume : 5  |  Issue : 2  |  Page : 279-280

Ulcerated calcinosis cutis


1 Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India
2 Department of Pathology, Government Medical College, Haldwani, Uttarakhand, India

Date of Web Publication15-Dec-2017

Correspondence Address:
Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani - 263 139, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_103_17

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  Abstract 

Calcinosis cutis is an uncommon disorder resulting in the deposition of calcium salts underneath the skin and subcutaneous tissues. Asymptomatic, giant lesion is a rare finding and rarer if present bilaterally over iliac bones. Frictional ulceration may at times be presenting feature of a chronic lesion that requires excisional biopsy.

Keywords: Bilateral, calcinosis cutis, ilium, treatment, ulcer, wound


How to cite this article:
Dharmshaktu GS, Pangtey T. Ulcerated calcinosis cutis. Arch Med Health Sci 2017;5:279-80

How to cite this URL:
Dharmshaktu GS, Pangtey T. Ulcerated calcinosis cutis. Arch Med Health Sci [serial online] 2017 [cited 2018 May 25];5:279-80. Available from: http://www.amhsjournal.org/text.asp?2017/5/2/279/220815



A 79-year-old woman presented to us with a wound over her right iliac region for the past 4 weeks. There was a fungating growth such as clinical picture with cheesy discharge and hard whitish granules of varying sizes within the wound [Figure 1]a and [Figure 1]b. The wound was present over the skin of the right iliac blades, and there was another similar lesion at identical contralateral side. The left side lesion was asymptomatic as well-defined bony hard swelling almost oval with normal overlying skin [Figure 1]c and [Figure 1]d. There was no increased temperature and tenderness at the left side, and both the swellings were present for the past 40 years. Both growths were asymptomatic till one of it (the right side) got an ulcerated wound with discharging whitish material probably due to frictional injury. There was no history of any comorbidity or prolong treatment with unremarkable blood and urine investigations including calcium, phosphorus, proteins, and renal function. She was managed by excision and histopathology confirmed calcinosis cutis [Figure 1]c. The wound healing was uneventful, and there was no recurrence for following 2 years.
Figure 1: Clinical pictures of frictional wound with white, chalky plaques of calcium within wound (a) and the radiograph of the same lesion as calcification over the right iliac blade (b). The contralateral side with hard, well.demarcated swelling over iliac blade (c) and corresponding radiographic lesion (d)

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Calcinosis cutis results from the deposition of calcium salts under the skin and subcutaneous tissues. Four types of the lesion metastatic, dystrophic, iatrogenic, and idiopathic are described. Idiopathic ones have no known features or disorders related to abnormal metabolism of calcium.[1] The growth may occasionally discharge calcium salts, thus supporting the diagnosis.[2] While the exact pathogenesis is unclear, various disorders are associated such as autoimmune connective tissue diseases including systemic sclerosis and dermatomyositis among others.[3] Hand, fingers, and feet are the most common sites to be involved. As our patient has long-standing asymptomatic lesions and was only here due to ulceration of one, she refused additional workup for associated conditions and also refused excision of contralateral lesion. Various medical therapies including calcium channel blockers, warfarin, bisphosphonates, immunoglobulin, and biologicals have been described with respective pros and cons. Surgery remains mainstay in localized and large problematic lesions.[4] The unique bilaterally symmetrical presentation at uncommon sites in our case is rare and highlights cautious and preventive approach to avoid potential complication of ulceration. Relevant investigations to rule out key-associated disorders are desirable for comprehensive diagnosis of this enigmatic condition.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kayhan TC, Temiz P, Ermertcan AT. Calcinosis cutis on the face. Indian J Dermatol Venereol Leprol 2009;75:180-1.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Sardesai VR, Gharpuray MB. Calcinosis cutis. Indian J Dermatol Venereol Leprol 2003;69:45-6.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Gutierrez A Jr., Wetter DA. Calcinosis cutis in autoimmune connective tissue diseases. Dermatol Ther 2012;25:195-206.  Back to cited text no. 3
    
4.
Valenzuela A, Chung L. Calcinosis: Pathophysiology and management. Curr Opin Rheumatol 2015;27:542-8.  Back to cited text no. 4
[PUBMED]    


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