Dermatology
Calcifying and Ossifying Disorders of the Skin
Built from Dermatology, 5th Edition
What’s inside
9 sections · 107 slides
Calcium and the skin
What calcium normally does in skin, and the two ways it can go wrong: calcification and ossification.
- What calcium does in normal skin
- Calcification versus ossification
- Five categories of cutaneous calcification
- The five categories at a glance
- Reading the classification table
- Disorders of cutaneous calcification
- Disorders of cutaneous calcification (continued)
Dystrophic calcification
Calcium deposits in skin that was already damaged - from autoimmune disease, panniculitis, genetic disorders, infection, tumors, or trauma.
- What triggers dystrophic calcification
- Dermatomyositis and CREST syndrome
- Where dermatomyositis calcification appears
- Dystrophic calcification in CREST syndrome
- Calcification in lupus and morphea
- Radiographic calcinosis cutis in generalized morphea
- Treating dystrophic calcification
- Sodium thiosulfate: injectable options
- Sodium thiosulfate: intralesional and intravenous administration
- Sodium thiosulfate: intralesional and intravenous administration (continued)
- Surgery and other local options
- Panniculitis-related calcification
- Genetic disorders: pseudoxanthoma elasticum
- Genetic disorders: Ehlers-Danlos and others
- Infections and tumors that calcify
- Trauma and other everyday triggers
- Dystrophic calcification after a neonatal heel stick
Metastatic calcification
When a body-wide problem with calcium or phosphate control deposits calcium into otherwise normal skin.
- What makes metastatic calcification different
- How failing kidneys cause it
- Mechanism of metastatic calcification in chronic kidney disease
- Benign nodular calcification
- Milk-alkali syndrome and hypervitaminosis D
Mixed calcification: calciphylaxis
A metabolic trigger plus tissue injury together cause this life-threatening clotting and calcium disorder of small blood vessels.
- What calciphylaxis is
- Calciphylaxis without kidney disease
- How calciphylaxis looks at first
- How calciphylaxis progresses
- Seeing the disease across its stages
- Early calciphylaxis mimicking cellulitis
- Early calciphylaxis with retiform purpura
- Reticulated violaceous plaques of calciphylaxis
- Clinical spectrum of calciphylaxis
- Calciphylaxis ulceration with retiform purpura
- Calciphylaxis of the girdle area
- Black eschar of calciphylaxis
- Large leg ulceration in calciphylaxis
- Calciphylaxis ulcer with fibrinous base
- Why recognizing it early matters
- Selye's original model: sensitizer plus challenger
- The sensitizer-challenger cascade
- What drives the vessel wall changes
- Who is at risk
- Diagnosis: what the labs actually show
- Skin biopsy: the imperfect gold standard
- Calciphylaxis on skin biopsy
- Vascular and connective tissue calcification in calciphylaxis
- Getting the best biopsy
- Ruling out the mimics
- Calciphylaxis and its differential diagnosis
- Treating calciphylaxis: the overall approach
- Anticoagulation and parathyroid treatment
- Sodium thiosulfate for calciphylaxis
- Other drug options
- Wound care and the debridement debate
- Hyperbaric oxygen and team-based care
Idiopathic calcification
Calcium deposits with no identifiable local damage and no metabolic cause - a diagnosis of exclusion.
- Idiopathic calcified nodules of the scrotum
- Vulvar calcinosis and treatment
- Subepidermal calcified nodule
- Tumoral calcinosis: sporadic and familial
- Familial tumoral calcinosis
- The genetics behind familial tumoral calcinosis
- Milia-like calcinosis
Iatrogenic calcification
Calcium deposits caused directly by a medical test or treatment.
- How iatrogenic calcification happens
- Common causes
Cutaneous ossification (osteoma cutis)
When calcium and phosphorus form true bone in the skin - either alongside calcification, or from an inherited defect in bone signaling.
- Four genetic causes of skin ossification
- Algorithm for evaluating cutaneous ossification
- Fibrodysplasia ossificans progressiva
- POH, plate-like osteoma cutis, and AHO
- The shared gene: GNAS1 and imprinting
- Progressive osseous heteroplasia on histology
- Osteoma cutis in Albright hereditary osteodystrophy
- Treating skin ossification
- Miliary osteomas of the face
- Miliary osteoma cutis of the face
- Osteoma cutis on histology
- Osteoma cutis islands of bone in the dermis
- Treating miliary osteoma cutis
- Ossification as a secondary event
Laboratory evaluation
Which blood and urine tests actually help sort out a calcifying or ossifying skin disorder.
- Building the workup
- Laboratory evaluation of patients with cutaneous calcification/ossification
- Reading the results
Pulling it together
The five categories, calciphylaxis, and osteoma cutis as one working framework.
- The five-category framework, revisited
- Calciphylaxis: what to never miss
- Osteoma cutis: what to remember
- One diagnostic habit worth keeping
- References
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- Dermatology, 5th Edition (2-Volume Set)