Hello, Susan. This is a real pleasure! You have perfectly described the difference between calcinosis cutis (common) … and calciphylaxis (rare). And, you have perfectly described delineations between the two conditions. The only thing I think you may have missed is the geographical shape of the calciphylaxis lesions and the fact that these lesions start as necrotic and exquisitely painful lesions. The major difference here is that CC is heterotopic bone in tissue (out side the blood vessel) and CP where the calcium is deposited within the blood vessels/capillary tree structure.

OK, enough said, on to the questions:

1) I think the incidence of calcinosis cutis is fairly common but often overlooked or mis-labeled in our practice. From my perspective, I’d answer this in the positive (yes, often) … and frequently in lower extremity wounds/lesions. I would note that CP wounds can be anywhere on the body, but tips of fingers, tip of the penis, nipples, etc are frequent. CP wounds that are trunkal in distribution tend to have worse outcomes than those on the tips of extremities.

2)I’m just going to tell you that I’m retired and don’t do daily wound care practice. However, I would think that after you have established a good wound bed, there should be no contraindication for skin substitutes. Beyond wound bed preparation, you make the excellent point that one must go after the cause of the calcium deposits in the first place. Regardless, these wounds/ulcers are difficult to heal. I’ll let others respond more on this question.

3) HBOT role … limited to none, especially in calcinosis cutis patients. There are case reports and small case series involving calciphylaxis and HBOT, but these are 20+ years old. I’d go scavenging in my “PDF library,” but I’m currently laid up after total knee surgery. So, you are getting only the benefit of my mind and drug-addled typing … waiting for the next pain pill to take effect (sorry). My main computer is 15 steps (EXACTLY) downstairs … not going to falls risk on that one. My surgeon would be highly upset with that decision.

Surgical intervention with CC. You have to be careful as I have seen these patients have increased heterotopic bone production after debridement or grafting or what have you. So, the answer for this is unknown.

Again, this was a real pleasure to discuss and one that is often overlooked or mis-labeled in our practices. I hope that this helped you. Others feel free to jump in!