Acquired perforating calcific collagenosis after topical calcium chloride exposure

Abstract

A 24-year-old healthy man presented with a 6-week history of numerous umbilicated coalescing erythematous papules with some scale and crust on his anterior medial thighs. The eruption began 1 to 2 weeks after he spilled calcium chloride rock salts on his pants while salting the sidewalk during a snow storm. The salts dissolved and remained in contact with his skin for at least 4 hours until he was able to change clothes. A skin biopsy shows thick and thin collagen fibers with partial calcification in the papillary and upper reticular dermis associated with a sparse infiltrate of neutrophils, lymphocytes and mononuclear histiocytes. There are foci of transepidermal elimination of calcified fibers with adjacent epidermal hyperplasia and ortho- and parakeratosis. Von Kossa stain highlights calcification of the fibers, and trichrome stain confirms the fibers are collagen. A Verhoeff-van Gieson stain shows no abnormality of elastic fibers. The patient was treated with topical betametasone diproprionate cream twice daily for 3 weeks, as well as a short course of oral levofloxacin and topical gentamicin cream. The lesions resolved over 3 weeks with residual scarring. We report a unique case of acquired perforating calcific collagenosis secondary to topical calcium chloride exposure.

Acquired perforating calcific collagenosis in a drug addict with rhabdomyolysis and transient hypercalcemia

“…The calcified fibers were identified to be collagen fibers and not elastic fibers by trichrome stain and Verhoeff‐van Gieson (VVG) stain. These changes were consistent with the so‐called APCC described in a previous case report …”

“…Deposits of calcium in the skin occur in a variety of cutaneous or systemic diseases. However, the deposition of calcium in the dermal collagen fibers with subsequent transepidermal elimination and perforation has only been described by Patel et al in 2010 in a patient with direct exposure to calcium chloride de‐icer. The condition was called APCC to characterize the histopathological changes.…”

“…1 Acquired perforating calcific collagenosis (APCC), which is characterized by the calcification of dermal collagen fibers with subsequent transepidermal elimination and perforation, has previously been reported in a patient with direct contact exposure to calcium chloride salt. 2 Here, we report a case of APCC because of transient hypercalcemia during the recovery phase of rhabdomyolysis in a drug addict.…”

“…These changes were consistent with the so-called APCC described in a previous case report. 2 The patient denied any topical calcium exposure or needle injection on the lesional sites. In fact, during hospitalization, hypocalcemia was detected initially, followed by the development of hypercalcemia up to 14.9 mg/dL (normal range 7.9-9.9 mg/dL) as of 2 weeks later, which gradually decreased to within the normal range.…”

Calcinosis cutis following contact with calcium chloride solution

“…In our patient the umbilicated papules studded with white deposits reflects TEE. A similar case of acquired perforating calcific collagenosis after topical CaCl 2 exposure has been previously reported in more detail 2 . CaCl 2 deposition following the use of calcium‐containing electroencephalography paste associated with TEE of calcified material has also been documented 3 .…”