Management for digital calcinosis in systemic sclerosis

Valenzuela, 2018

Calcinosis is commonly seen in both limited and diffuse systemic sclerosis; see Limited cutaneous systemic sclerosis for an image of extruding calcinotic deposits in limited cutaneous systemic sclerosis. Calcinosis affects the hands most commonly and is painful and debilitating.

Management for painful, extruding digital calcinosis is difficult. Adequate analgesia should be given; see Using analgesics to manage acute pain.

Any sign of soft-tissue infection around extruding digital calcinosis should be treated with antibiotics early, as early management may prevent the loss of digital pulp space. Suspect infection if the wound becomes increasingly painful, red, swollen or discharging.

For management of infected digital calcinosis, see Principles of managing cellulitis and erysipelas. It is important to remain alert to spreading infection that may cause septic arthritis or osteomyelitis, see the separate topics for management.

If digital ulcers and calcinosis fail to heal, surgical debridement and excision of substantial underlying calcinosis may be necessary to allow healing.

Digital ulcers require protection and regular dressings using preparations such as povidone-iodine; see Guide to choosing an ulcer or wound dressing for advice on dressing choice.

Despite reports that warfarin, calcium channel blockers and colchicine may be effective for digital calcinosis, there are no drugs of established value.