Calcium Deposits on the Face: Causes and Treatment

There are certain conditions that cause calcium deposits on the face and skin, known as calcinosis cutis. These include certain autoimmune disorders, acne, kidney disease, and high-dose calcium medications. The deposits are caused by the build-up of calcium under the skin and appear as firm whitish or yellowish bumps.

Calcinosis cutis is not always serious but, depending on the underlying cause, can be a sign of a serious medical condition. This is why it is important to see a healthcare provider if you find hardened deposits under your skin.

This article explains the symptoms, causes, and diagnosis of calcinosis cutis as well as the current options for treatment.

Calcinosis Cutis Symptoms

Calcinosis cutis causes small, hard, white or yellowish lumps under the skin. The lumps can vary in size and often appear in clusters. They are generally slow-growing and often start with redness or itching. Even so, most people have no symptoms before the lumps appear.

Calcinosis cutis can occur anywhere on the body but is most common on:

• Face
• Elbows
• Fingertips
• Knees
• Forearms
• Shins
• Buttocks
• Scalp
• Eyelids
• Scrotum

The lesions usually cause no pain but can be upsetting if they appear on the face. In rare cases, calcium can build up within joints. If the skin lesions break open or are punctured, a pasty substance may drain out.

Some forms of calcinosis cutis are non-progressive and many have little impact on a person's life or appearance. Others can progress and lead to potentially serious complications, including:

• Skin ulcers
• Joint deformity
• Disfiguring lesions (particularly those on the face)
• Joint pain and stiffness
• Paresthesia (burning or tingling sensations)
• Muscle or tendon tightness
• Loss of mobility
  

Types and Causes of Calcinosis Cutis

Calcinosis cutis can occur when excessive amounts of calcium or phosphate accumulate in the body and are not excreted in urine as they should.

Calcium and phosphate are minerals that the body needs to function. They are involved in building bones, maintaining heart rhythm, and other key bodily functions.

The condition can also occur when tissue damage triggers the release of proteins that bind calcium in clumps.

There are four major types of calcinosis cutis:

Dysmorphic Calcinosis Cutis

Dysmorphic calcinosis cutis occurs when damaged tissues release proteins that bind calcium and phosphate, creating clumps that gradually increase in size. The term dysmorphic translates to "abnormal shape."

Causes include autoimmune diseases like lupus, rheumatoid arthritis, and scleroderma as well as inflammatory conditions like acne and varicose veins. Severe burns, lacerations, and bacterial skin infections can also lead to dysmorphic calcinosis cutis.

Iatrogenic Calcinosis Cutis

Iatrogenic calcinosis cutis is caused by the excessive intake or absorption of calcium due to medical procedures. Examples include intravenous (IV) calcium used to treat tuberculosis or calcium chloride paste used on electrodes for brain scans.

Iatrogenic calcinosis cutis is also common in organ transplant recipients who receive compounds like sucralfate that increase blood calcium levels.

The term iatrogenic refers to conditions that are caused by medical treatments or decisions.

Metastatic Calcinosis Cutis

Metastatic calcinosis cutis occurs when calcium or phosphate levels are high but there is no tissue damage. When phosphate levels are high, they naturally bind to calcium.

The term metastatic typically refers to the spread of cancer from the original tumor. But with metastatic calcinosis cutis, the term includes other conditions that are malignant (progressively worsening), including:

• Chronic kidney disease
• Hyperparathyroidism (overactive parathyroid gland)
• Sarcoidosis (an inflammatory disease characterized by granular clumps known as granulomas)
• Paget disease (a rare disease that causes accelerated bone growth and tumors)
  
• Calciphylaxis (a poorly understood condition associated with end-stage kidney disease)
• Certain cancers, including breast, kidney, or lung cancer as well as multiple myeloma and squamous cell skin cancer

Metastatic calcinosis cutis can also be caused by vitamin D toxicity mainly triggered by the overuse of vitamin D supplements.

Idiopathic Calcinosis Cutis

Idiopathic calcinosis cutis occurs when calcium and phosphate levels are normal and no cause for the condition is found. The term idiopathic describes diseases or disorders of unknown origin. Genetics is thought to play a central role in idiopathic calcinosis cutis.

Examples of idiopathic calcinosis include:

• Familial tumoral calcinosis (typically affecting joints in healthy teens) 
• Subepidermal calcified nodules (typically affecting the scalp, face, and eyelids)
• Scrotal calcinosis (which causes hardened lumps on the scrotum)

How Calcinosis Cutis Is Diagnosed

The diagnosis of calcinosis cutis starts with an examination of the skin and a review of your medical history. Blood tests will be ordered to see if your calcium or phosphate levels are high.

The doctor may order other blood tests to see if an underlying disease is involved. The tests may include:

• Renal function tests to check for kidney disease
• Parathyroid hormone level to check for hyperparathyroidism
• C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to check for inflammation, such as can occur with autoimmune diseases

Imaging studies, including computed tomography (CT) scans and bone scans, can determine the extent of the calcium deposits.

Because calcinosis cutis can be confused with other things—like milia (whiteheads) and gouty tophi (skin growths caused by gout)—a procedure called a biopsy may be ordered to obtain a tissue sample and confirm the diagnosis.

How Are Calcium Deposits on the Skin Treated?

Because there are many different causes for calcinosis cutis, there are many possible treatments. With that said, treatment may not be needed if the deposits are not causing discomfort or distress.

In some cases, calcinosis cutis will clear on its own once the underlying condition is treated or the underlying trigger (like excessive vitamin D or calcium intake) is removed. Others may clear spontaneously for no known reason.

Home Remedies and Lifestyle

There are no proven home remedies to treat calcinosis cutis. Even so, some people swear by the use of apple cider vinegar. This is evidenced by a small study published in 2016 which suggests that the application of apple cider vinegar on the skin may partially alleviate the calcification associated with varicose veins.

What may be arguably more effective is avoiding things that can lead to calcinosis cutis, including:

• Avoiding injury to the skin, including sun damage and damage caused by acne
• Avoiding triggers for autoimmune diseases like rheumatoid arthritis and gout
• Avoiding the overuse of calcium, phosphate, or vitamin D supplements
• Quitting cigarettes, which increases phosphate levels in the blood

Prescription Medications

Calcium channel blockers like Cardizem (diltiazem), Norvasc (amlodipine), and Verelan (verapamil) are among the first-line drugs used to treat calcium skin lesions. They work by lowering the amount of calcium taken up by skin cells.

The steroid drug prednisone and anti-inflammatory drug Colcrys (colchicine) can reduce inflammation and shrink calcium deposits. The blood thinner Coumadin (warfarin) has similar effects.

Procedures

To get the best long-term results, your healthcare provider will need to treat the root cause of your symptoms. However, the lesions can be removed or reduced for cosmetic purposes or if they are affecting joint mobility.

Options include:

• Surgical excision (using a scalpel and incision)
• Laser therapy (using a light or carbon dioxide laser)
• Iontophoresis (using electrical currents and calcium-dissolving substances to break up deposits)
• Arthroscopic debridement (using a scope and tiny keyhole incisions to access a damaged joint and scrape away excess calcium)
  

Summary

Calcinosis cutis is the deposit of calcium under the skin that causes firm whitish or yellowish bumps. It can be caused either when the level of calcium or phosphate in the body is high or when skin trauma causes the body to release proteins that bind calcium into clumps.

The diagnosis may involve a physical exam, blood tests, imaging studies, and a biopsy. If needed, calcinosis cutis can be treated with drugs like calcium channel blockers, prednisone, or colchicine. The lesions can be removed with surgery, lasers, or other procedures.