Two Cases of Dystrophic Calcinosis Cutis in Burn Scars

Spätmanifeste Kalzinose in Brandnarben: Eine Literaturübersicht und zwei Fallberichte

Calcinosis cutis, die heterotope Ablagerung von Kalziumsalzen in der Haut, wurde in einigen Fällen als spät auftretende Komplikation von Brandnarben beschrieben. Sie unterscheidet sich diesbezüglich von heterotoper Ossifikation, die eine früh einsetzende Komplikation von Brandverletzungen sein kann. Die Diagnose einer Kalzinose kann radiographisch, sonographisch, computertomographisch, magnetresonanztomographisch oder histologisch bestätigt werden. Nahezu alle Fälle einer spätmanifesten Kalzinose bei Brandnarben imponieren als nicht heilendes Ulkus an den unteren Extremitäten in der Nähe der Kontrakturbänder. Es wird diskutiert, dass diese Lokalisation auf die häufigeren Mikrotraumen an den unteren Extremitäten zurückzuführen ist, und dass die Ulzeration aufgrund der Kalziumablagerungen als Fremdkörper auftritt. In unserer Studie betrug das Durchschnittsalter zum Zeitpunkt der Brandverletzung 12,5 ± 8,27 Jahre und die Kalzinose entwickelte sich im Mittel nach einer Zeitspanne von 37,5 ± 14,95 Jahren (das Durchschnittsalter bei Beginn war 50,5 ± 14,53 Jahre). Es gab keinen signifikanten Unterschied zwischen Brandnarben, die mittels Hauttransplantation behandelt wurden, und solchen, bei denen keine Hauttransplantation durchgeführt wurde. Die Ulzera verheilten nach Resektion oder Extraktion der Ablagerungen ohne Rezidiv an derselben Stelle. Im Gegensatz zu früher gemeldeten Fällen beobachteten wir zwei Fälle einer spät einsetzenden Kalzinose ohne Ulzeration bei Brandnarben an den oberen Extremitäten.

Late-onset calcinosis in burn scars: A review of the literature and two case reports

Calcinosis cutis is a heterotopic accumulation of calcium salts in the skin. It has been described as a late‐onset complication of burn scars in a few cases, in contrast to heterotopic ossification, which may be an early‐onset complication of burn injuries. Diagnosis of calcinosis can be confirmed by radiography, ultrasonography, computed tomography, magnetic resonance imaging or histology. Almost all cases of late‐onset calcinosis in burn scars present as non‐healing ulcers on the lower extremities near contracture bands. It has been hypothesized that this localization is due to the more frequent microtrauma of the lower extremities, and that ulceration is due to the presence of calcium deposits as foreign bodies. In our study, the mean age at the time of burn injury was 12.5 ± 8.27 years, and calcinosis developed after a mean time of 37.5 ± 14.95 years (mean age at onset was 50.5 ± 14.53 years). There was no significant difference between burn scars managed with skin grafting and those where skin grafting was not carried out. The ulcers healed after resection or extraction of the deposits without any recurrence at the same site. In contrast to previously reported cases, we observed two cases of non‐ulcerating late‐onset calcinosis in burn scars of the upper extremities.

Photoletter to the editor: Calcinosis cutis in a burn scar

Calcinosis cutis is a rare condition characterized by the deposition of insoluble calcium salts in the skin and subcutaneous tissue. Dystrophic calcinosis cutis appears as a result of local tissue damage or abnormalities, such as alterations in extra-cellular matrix proteins or subcutaneous tissue with normal calcium and phosphate serum levels. It has been rarely described as a late complication of burns. Latency periods of 15-54 years have been reported. We describe the case of a 57-year-old man with dystrophic calcinosis cutis in a burn scar, which developed 42 years after the skin injury. The condition was successfully treated with surgical excision.

Calcinosis cutis: part I. Diagnostic pathway

Calcinosis cutis is characterized by the deposition of insoluble calcium salts in the skin and subcutaneous tissue. The syndrome is separated into five subtypes: dystrophic calcification, metastatic calcification, idiopathic calcification, iatrogenic calcification, and calciphylaxis. Dystrophic calcification appears as a result of local tissue damage with normal calcium and phosphate levels in serum. Metastatic calcification is characterized by an abnormal calcium and/or phosphate metabolism, leading to the precipitation of calcium in cutaneous and subcutaneous tissue. Idiopathic calcification occurs without any underlying tissue damage or metabolic disorder. Skin calcification in iatrogenic calcinosis cutis is a side effect of therapy. Calciphylaxis presents with small vessel calcification mainly affecting blood vessels of the dermis or subcutaneous fat. Disturbances in calcium and phosphate metabolism and hyperparathyroidism can be observed.