10.5826/dpc.1203a120
text/xml
2160-9381
1730
en
Sümeyra Has
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
Calcinosis cutis, dermoscopy, dystrophic calcification, leg ulcer
Calcinosis cutis in association with long-term stasis after electrical burn injury: a case report
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-07-28
2021-04-13
2022-07-28
2022-09-15
e2022120
Dermatol Pract Concept
Sümeyra Has
2022/07/28
10.5826/dpc.1203a120
e2022120
Kırşehir Training and Research Hospital, Department of Pathology, Kırşehir, Turkey
2160-9381
Calcinosis cutis, dermoscopy, dystrophic calcification, leg ulcer
en
e2022120
Uyar B, Elmas OF, Acar EM, Has S. Calcinosis cutis in association with long-term stasis after electrical burn injury: a case report. [OP-025] In 5th Indercos Congress, 12-15 March 2020 in İstanbul-Turkey. Available from: https://indercos.org/2020/docs/Full_Abstracts.pdf?a=9999
Calcinosis cutis in association with long-term stasis after electrical burn injury: a case report
https://dpcj.org/index.php/dpc/article/download/1730/1651
                    Dermatology Practical & Conceptual


      Calcinosis Cutis in Association With Long-term
     Stasis After Electrical Burn Injury: a Case Report
                  Belkız Uyar1, Ömer Faruk Elmas2, Emine Müge Acar3, Sümeyra Has4


1 Düzce University, Faculty of Medicine, Department of Dermatology, Düzce, Turkey
2 Kırıkkale University, Faculty of Medicine, Department of Dermatology, Kırıkkale, Turkey
3 Kırşehir Training and Research Hospital, Department of Dermatology, Kırşehir, Turkey
4 Kırşehir Training and Research Hospital, Department of Pathology, Kırşehir, Turkey



Keywords: calcinosis cutis, dermoscopy, dystrophic calcification, leg ulcer
Citation: Uyar B, Elmas ÖF, Acar EM, Has S. Calcinosis cutis in association with long-term stasis after electrical burn injury: a case report.
Dermatol Pract Concept. 2022;12(3):e2022120. DOI: https://doi.org/10.5826/dpc.1203a120
Accepted: October 31, 2021; Published: July 2022
Copyright: ©2022 Uyar et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License
(BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/which permits unrestricted noncommercial use, distribution, and reproduction
in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Belkız Uyar, Merkez, Yörükler Mah Konuralp yerleşkesi, 81620 Düzce Merkez/Düzce,
Telephone: 90 380 543 13 90-6324 GSM: 05057408812, E-mail address: belkisuyar@gmail.com




Introduction                                                             scales (Figure 2A). A thick, profuse, white, chalky material
                                                                         was discharged from the hole created via a punch biopsy
Calcinosis cutis is an uncommon disorder caused by an ab-                (Figure 1B).
normal deposit of calcium phosphate in the skin [1].                          Histopathological examination revealed hyperkeratosis,
                                                                         acanthosis, superficial dermal vascular proliferation along
                                                                         with dermal and subcutaneous calcification foci. X-ray ex-
Case Presentation
                                                                         amination showed irregular-defined calcified foci over the
A 55-year-old male patient with a long-lasting wound on the              posterior aspect of the distal end of the fibula extending in
left ankle presented with complaints of swelling and itching             a linear fashion (Figure 2B). Arterial and venous Doppler
on his left ankle. According to his medical history, he had an           ultrasound examinations revealed normal findings.
electric shock to the left leg 33 years before and the wound                  Biochemical parameters including liver and renal func-
was closed with grafting. Ulceration developed at the same               tion tests, alkaline phosphatase, serum calcium, phosphorus,
site 2 years before he presented at our clinic.                          sodium, potassium, vitamin D levels, parathyroid hormone
    On physical examination, he had an erythematous, ul-                 levels, CEA, AFP, CA-15-3, CA-19-9, total PSA were within
cerated, sclerotic, 20 cm x 15 cm in size wound over the left            normal limits.
lateral malleolus. On this wound, there were three fluctuat-                  The patient was diagnosed with a stasis ulcer with dys-
ing masses with overlying intact skin which were 1 x 1.5,                trophic calcification and was managed with extremity eleva-
1 x 2 and 3x3 cm in size, respectively (Figure 1A). Dermo-               tion, wound dressing and oral diltiazem. The patient, who
scopic examination showed blue to gray structureless ar-                 has been under our control for 18 months, has not had a
eas, numerous coiled vessels with patchy distribution and                recurrence of the fluctuating mass (Figure 1C).



Research Letter | Dermatol Pract Concept. 2022;12(3):e2022120                                                                               1
Figure 1. (A) An erythematous, ulcerated, sclerotic wound over the left lateral malleolus and three fluctuant masses. (B) A thick, profuse,
white, chalky material discharged from the hole created via a punch biopsy. (C) 18 months after the treatment, it is seen that the fluctuant
masses still do not recur.




Figure 2. (A) Dermoscopic appearance: blue to gray structureless areas, numerous coiled vessels with patchy distribution and scale. (B) X-ray
of the left lower leg showing irregular-defined calcified foci over the posterior aspect of the distal end of the fibula extending in a linear
fashion.


Informed consent: Written informed consent for publication                   In the literature there a few studies on dystrophic calcifi-
of clinical details and clinical images was obtained from the            cation due to stasis developed as a result of chronic venous
patient.                                                                 insufficiency [1]. Arterial and venous Doppler results of our
                                                                         patient were normal. However, the stasis might have been
                                                                         caused by worsened lymphatic drainage due to previous op-
Conclusions
                                                                         erations and tissue damage experienced by the patient.
Cutaneous calcification has been divided into five major                     Dystrophic calcification is reported to be a rare cause of
types according to etiology: dystrophic calcinosis is the most           non-healing leg ulceration [2]. It should be kept in mind that
common type of calcinosis that is associated with infection,             dystrophic calcification of the skin may also be associated
inflammatory processes, cutaneous neoplasm, or connective                with persistent ulceration in the setting of stasis.
tissue diseases. Other types of calcinosis cutis are metastatic              The treatment of calcinosis cutis is not well-established.
calcification, idiopathic calcinosis cutis, iatrogenic, and              Apremilast, diltiazem, bisphosphonates, probenecid, aluminum
mixed calcinosis [1,2].                                                  hydroxide, aimed at altering the serum calcium-phosphorus



2                                                                            Research Letter | Dermatol Pract Concept. 2022;12(3):e2022120
levels, have been tried. Long-term treatment with diltiazem          J. 2005;2(2):142-147. DOI: 10.1111/j.1742-4801.2005.00096.x.
was reported to decrease the size of calcium deposits. Surgical      PMID: 16722863. PMCID: PMC7951336.
                                                                  2. Uyar B, Elmas OF, Acar EM, Has S. Calcinosis cutis in associa-
excision or curettage is appropriate in selected patients [2].
                                                                     tion with long-term stasis after electrical burn injury: a case re-
                                                                     port. [OP-025] In 5th Indercos Congress, 12-15 March 2020 in
References                                                           İstanbul-Turkey. Available from: https://indercos.org/2020/docs/
                                                                     Full_Abstracts.pdf?a=9999
 1. Enoch S, Kupitz S, Miller DR, Harding KG. Dystrophic cal-
    cification as a cause for non-healing leg ulcers. Int Wound




Research Letter | Dermatol Pract Concept. 2022;12(3):e2022120                                                                         3
