Is calcinosis (calcium deposit disease) recurrent?

From the Guidelines

Calcinosis can recur after treatment, and its management should focus on addressing the underlying conditions causing it, as well as monitoring for new deposits and adjusting treatment as needed. Calcinosis, which involves calcium deposits forming in skin and tissues, often returns because the underlying conditions causing it persist. Treatments like surgical removal, laser therapy, or medications such as diltiazem, colchicine, or warfarin may provide temporary relief, but recurrence is common unless the root cause is addressed 1. For patients with autoimmune conditions like scleroderma or dermatomyositis, ongoing management of the primary disease is essential. The recurrence happens because calcium metabolism abnormalities or tissue damage continues to trigger deposit formation.

Some key points to consider in the management of calcinosis include:

• The safety and efficacy of diltiazem, rituximab, minocycline, and treprostinil for calcinosis in systemic sclerosis are primarily based on case reports and small retrospective case series 1.
• Topical or non-pharmacological treatments for calcinosis, such as carbon dioxide laser therapy, surgical debulking, and topical sodium thiosulfate, have been studied, but these studies have several limitations, including retrospective design, small sample sizes, and lack of control groups 1.
• Regular follow-up with healthcare providers is important to monitor for new deposits and adjust treatment as needed.
• Lifestyle modifications like maintaining proper calcium and vitamin D levels may help reduce recurrence risk in some cases, though evidence for this is limited 1.

Overall, the management of calcinosis should be individualized and based on the underlying condition causing it, as well as the patient's overall health status and quality of life. The most recent and highest quality study, published in 2025, highlights the limited evidence available to guide the treatment of calcinosis, and emphasizes the need for further research in this area 1.

From the Research

Calcinosis Recurrence

• Calcinosis cutis is a chronic condition involving insoluble calcified deposits of the skin and subcutaneous tissue, commonly associated with autoimmune connective tissue diseases 2.
• The condition can cause pain, chronic ulcerations, infections, and functional disability, and its management is challenging due to the lack of a uniformly effective treatment 3.
• Various treatments have been used, including surgical excision, laser therapy, extracorporeal shock wave lithotripsy, diltiazem, minocycline, colchicine, and topical sodium thiosulfate, but no treatment has convincingly prevented or reduced calcinosis 4.
• Calcinosis may be the source of both pain and disability in connective tissue disease patients, and its recurrence is a significant concern 4.
• The approach to calcinosis management is disorganized, and there is a lack of systematic study and clinical therapeutic trials, making it difficult to determine the most effective treatment for preventing recurrence 4.

Treatment and Recurrence

• Surgical excision is often effective for localized forms of small lesions, but may not prevent recurrence in disseminated cases 3.
• Medical therapies, such as calcium blockers and colchicine, are generally prescribed as the first line of systemic therapy, but their effectiveness in preventing recurrence is unclear 3.
• Additional treatments, such as aluminium hydroxyde and bisphosphonates, may be required for disseminated calcinosis, but their impact on recurrence is not well established 3.
• The time to response to treatment may be prolonged, ranging from weeks to months, and the condition can lead to secondary infection, pain, and functional disability if not properly managed 3.

Current Understanding

• The pathophysiology of calcinosis cutis is poorly understood, and local trauma, chronic inflammation, and vascular hypoxia have been proposed as potential pathomechanisms 5.
• The development of mouse models that mimic heritable ectopic mineralization disorders is contributing to the understanding of the process of calcification, but more research is needed to determine the most effective treatments for preventing recurrence 5.
• Calcinosis cutis affects almost one quarter of patients with systemic sclerosis, and is associated with longer disease duration, digital ulcers, acroosteolysis, positive anticentromere antibody, and positive anti-PM/Scl antibody 5.