Calcinosis Cutis Circumscripta
- Calcinosis cutis refers to a group of disorders in which calcium salts get deposited in the skin.
- It is classified into 4 major types according to etiology: dystrophic, metastatic, iatrogenic, and idiopathic.
- The dystrophic form is the most common and is seen with connective tissue diseases, infections, other inflammatory processes, chronic venous stasis, cutaneous neoplasm, and trauma. The exact mechanism remains unclear.
- Metastatic calcification are related to abnormal calcium or phosphate metabolism and is generally associated with hypercalcaemia and/or hyperphosphatemia.
- Iatrogenic calcinosis cutis arises as complication of a therapeutic and or diagnostic procedure.
- Idiopathic calcinosis cutis, as in this case, occurs in the absence of any of the above causes.
- The calcifications can be either localized (calcinosis circumscripta) or diffuse (calcinosis universalis).
- CT is the examination of choice for demonstrating the calcifications. It also allows for visualization of associated soft tissue abnormalities.
- Lesions can be painful and disfiguring. Treatment depends on underlying etiology. Medical treatment, in general, has poor outcome. Surgery is reserved for refractory cases. Histology shows amorphous calcific deposits in the dermis that are easily demonstrated on hematoxylin and eosin stain.
- Our patient did not recall any history of trauma or prior intervention to his periauricular region. Laboratory studies showed normal serum calcium, inorganic phosphate, and alkaline phosphatase. Parathyroid hormone, vitamin D, and renal function were also within normal. Patient did not have collagen vascular disease. CT did not show an underlying vascular lesion and no other lesions were detected on physical exam. This case was hence labeled calcinosis cutis circumscripta. Patient failed to improve on medical therapy, which included corticosteroids, colchicine, topical creams, antibiotics for superimposed infections, and a course of Calcipotriene ointment. He was offered surgery, which would include parotidectomy, possible partial tyemporal bone resection for exposure of the distal intratemporal facial nerve, and reconstruction of skin defect.