Subtype | Etiology | Common clinical findings | Associated manifestations |
Dystrophic | Systemic sclerosis | Firm papules, plaques or nodules usually on the hands, feet, or extremities, often in sites of minor trauma | Limited systemic sclerosis (cutaneous sclerosis primarily involving hands and distal forearms), CREST syndrome |
Dermatomyositis | Firm papules, plaques or nodules on the extremities (particularly elbows, knees, shoulders, and buttocks), often in sites of repeated trauma; deposits may be intracutaneous, subcutaneous, fascial, or intramuscular | Gottron papules, heliotrope eruption, poikiloderma, periungual capillary changes, proximal muscle weakness | |
Systemic lupus erythematosus | Often an asymptomatic incidental radiologic finding; often buttocks and extremities | Manifestations of systemic lupus erythematosus | |
Pancreatic enzyme panniculitis | Painful subcutaneous nodules, often on pretibial skin with ulceration; may drain an oily substance | Manifestations of pancreatic disease, particularly pancreatitis or pancreatic adenocarcinoma | |
Subcutaneous fat necrosis of the newborn | Erythematous nodules and plaques, especially on cheeks, back, buttocks, and extremities | Risk of hypercalcemia | |
Lupus panniculitis | Firm subcutaneous nodules on the head, proximal extremities, or trunk | Systemic lupus erythematosus may or may not be present | |
Porphyria cutanea tarda | Firm plaques within sites of cutaneous sclerosis that may exhibit ulceration or transepidermal elimination of calcium; usually on head, neck, or dorsal hands | Photosensitivity, skin fragility, blistering, sclerodermoid changes | |
Pseudoxanthoma elasticum | Clinically evident calcification rare; if occurs, may exhibit papules or nodules extruding calcium | Yellowish papules in flexural areas, angioid streaks, cardiovascular abnormalities | |
Werner syndrome | Painful soft tissue calcification with ulceration, usually involving Achilles tendon and knee or elbow tendons | Premature aging, scleroderma-like skin changes | |
Ehlers-Danlos syndromes | Calcified spheroids, focal subcutaneous calcification, calcification within molluscoid pseudotumors | Connective tissue abnormalities (eg, skin hyperextensibility, joint hypermobility, tissue fragility) | |
Cutaneous neoplasms | Most common in pilomatricomas; sometimes only noted histologically | N/A | |
Trauma | Firm, whitish papules or subcutaneous nodules | History of injury to involved area; may precede calcification by years | |
Onchocerciasis | Subcutaneous nodules (onchocercomas) that may calcify over time | Ocular changes, pruritus, papular eruptions, hypopigmentation | |
Cysticercosis | Papulonodules | Seizures, headache, nausea, vomiting if neurologic involvement | |
Metastatic | Chronic renal failure | Firm nodules, particularly at periarticular sites | Often normal serum calcium and increased serum phosphate |
Hypervitaminosis D | Periarticular calcification | Symptoms of hypercalcemia and hypercalciuria (weakness, lethargy, headache, nausea, polyuria) | |
Albright hereditary osteodystrophy | Symmetric cutaneous ossification | Pseudohypoparathyroidism, intellectual disability, obesity | |
Malignancy | Firm, whitish papules or subcutaneous nodules | Signs or symptoms of a bone-destroying malignancy | |
Idiopathic | Idiopathic calcification of the scrotum | Firm, white subcutaneous nodules on the scrotum | N/A |
Subepidermal calcified nodule | Solitary hard, white papules usually on the head, neck, or upper extremities; less frequently, multiple nodules occur | N/A | |
Tumoral calcinosis | Large calcium deposits around major joints (eg, hips, shoulders, elbows, knees) | Some patients have hyperphosphatemia | |
Iatrogenic | Iatrogenic | Firm papules, nodules, or plaques | History of intravenous therapy or other medical procedure |
Calciphylaxis | Calciphylaxis | Painful retiform purpura, stellate ulcers, particularly in areas with high adiposity (eg, buttocks, thighs) | End-stage kidney disease, primary hyperparathyroidism, malignancy, liver disease, connective tissue diseases |
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