Calcinosis cutis

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Calcinosis cutis on a dog associated with hyperadrenocorticism[1]
Lateral radiograph of the left hind paw of a 7-month-old terrier cross with calcinosis circumscripta of the metatarsal pad and skin on the dorsal medial side of the paw, secondary to chronic renal disease[2]

Calcinosis cutis is a skin disease of dogs characterized by dystrophic calcium deposition in the dermis and subcutis.

This deposition of calcium is thought to be due to phase transformation of calcium and phosphate ions from solution into crystalline aggregate with deposition in matrices of dermal collagen and elastin. Calcinosis cutis (or cutaneous calcification) is a type of calcinosis wherein calcium deposits form in the skin. A variety of factors can result in this condition.

Two forms of calcium deposition in skin are recognized:

  • Calcinosis circumscripta - idiopathic, dystrophic (following tissue damage), metastatic (high serum calcium or phosphate) or iatrogenic (use of parenteral calcium or other drugs) mineralization characterized by localized deposition of calcium salts in soft tissues, affecting bony prominences, footpads or tongue[3], often seen in young (under 2 years of age) large breed dogs[4][5] - may developed into large subcutaneous masses[6]
  • Calcinosis cutis - disseminated calcium deposition - secondary to dystrophic or metastatic causes, often disseminated across the body rather than localized

In dogs, calcinosis cutis is virtually pathognomonic for hyperadrenocorticism[7]

Other causes of cutaneous calcium deposition include:

- Blastomyces spp[9]
- Paecilomyces variotii[10]

Clinically, these lesions appear on the skin as non-pruritic firm red to white plaques with hyperproliferative margins, and may appear on the head, ears, dorsal midline, neck, ventral abdomen, internal thigh surface, inguinal areas and pads. Alopecia and scurfy skin may be associated with these lesions and secondary pododermatitis may also develop.

Histologically, these lesions appear as areas of deposition of dense, amorphous granular basophilic calcium salts separated by thin fibrous connective tissue containing mild inflammation.

A differential diagnosis would include Leishmania spp infection, dermatofibrosis, Alopecia X, fibrodysplasia ossificans[14] and follicular dysplasia.

There is no specific treatment for this condition and the underlying disease process must be primarily addressed to resolve this condition, although the use of oral charcoal adsorbents has been shown to ameliorate the condition once the underlying condition has been treated[15].

References

  1. Dr R. Hilton
  2. Joffe DJ (1996) Calcinosis circumscripta in the footpad of a dog. Can Vet J 37(3):161-162
  3. Marcos R et al (2006) Cytochemical detection of calcium in a case of calcinosis circumscripta in a dog. Vet Clin Pathol 35(2):239-242
  4. Tafti AK et al (2005) Calcinosis circumscripta in the dog: a retrospective pathological study. J Vet Med A Physiol Pathol Clin Med 52(1):13-17
  5. Jeong W et al (2004) Calcinosis circumscripta on lingual muscles and dermis in a dog. J Vet Med Sci 66(4):433-435
  6. Bettini G et al (2005) True grit: the tale of a subcutaneous mass in a dog. Vet Clin Pathol 34(1):73-75
  7. Hsu K et al (2012) Iatrogenic hyperadrenocorticism, calcinosis cutis, and myocardial infarction in a dog treated for IMT. J Am Anim Hosp Assoc 48(3):209-215
  8. Muller A et al (2011) Metastatic calcinosis (including calcinosis cutis) in a young dog with multiple urinary tract abnormalities. Vet Dermatol 22(3):279-283
  9. Gortel K et al (1999) Calcinosis cutis associated with systemic blastomycosis in three dogs. J Am Anim Hosp Assoc 35(5):368-74
  10. Holahan ML et al (2008) Generalized calcinosis cutis associated with disseminated paecilomycosis in a dog. Vet Dermatol 19(6):368-372
  11. Munday JS et al (2005) Generalized calcinosis cutis associated with probable leptospirosis in a dog. Vet Dermatol 16(6):401-406
  12. Ramsey IK et al (2005) Hyperparathyroidism in dogs with hyperadrenocorticism. J Small Anim Pract 46(11):531-536
  13. Schaer M et al (2001) Severe calcinosis cutis associated with treatment of hypoparathyroidism in a dog. JAAHA 37:364-369
  14. Guilliard MJ (2001) Fibrodysplasia ossificans in a German shepherd dog. J Small Anim Pract 42(11):550-553
  15. Komori S & Washizu M (2001) Metastatic calcinosis circumscripta treated with an oral charcoal absorbent in a dog. J Vet Med Sci 63(8):913-916
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