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Scleroderma is an autoimmune disease. The body’s immune system mistakenly turns on itself and attacks its own organs as foreign intruders, resulting in inflammation. This process also produces excess collagen, a protein used in connective tissues, such as skin and cartilage. The excess collagen causes patches of hardened skin. Scleroderma can either be localized, involving primarily the skin, or generalized, which includes internal organs.
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Calcifications Caused by Scleroderma
A specific type of scleroderma called limited cutaneous scleroderma often causes calcium deposits to form beneath the skin, most often in the fingers, upper arm muscles near the elbow joint, or on the shins near the knee joints. The calcification of upper arm muscles caused by scleroderma is common in late-stage disease and occur most often in people who have had the disease for at least 5 years. The calcifications, also called calcinosis, start as small lumps of calcium detectable only by x-ray. The calcifications grow and eventually may be felt with the fingers. In some cases, the calcifications erupt through the skin, leaking a thick white fluid that may contain small granules.
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Cause and Prevention
Dietary calcium intake does not contribute to calcification of upper arm muscles caused by scleroderma. Researchers have not pinpointed the exact cause, but the calcifications result from scleroderma-associated tissue damage. The calcifications cannot be prevented, but good skin care can help prevent skin breakdown that allows the deposits to erupt.
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Calcifications in the upper arms caused by scleroderma progress slowly. Although this form of scleroderma is tends to be less severe than other forms, internal organs become damaged over time. Calcifications may become inflamed, resulting in a painful swelling of the arm. The lumps may become large and break though the skin, leaving open sores that are may be susceptible to infection. Ulcerated calcifications should be cleansed thoroughly with soap and water and covered with a sterile bandage. Seek immediate medical attention if the sore becomes red, swollen, or begins to drain.
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No treatment is available to cure or stop the progression of calcifications in the upper arms caused by scleroderma, but medications may help relieve symptoms and prevent infection. Minocycline may help reduce calcifications and inflammation. Pentoxifylline is effective in some cases. Colchicine helps reduce the inflammation resulting from the calcification and is discontinued when the swelling subsides. Severe calcifications may require surgical removal. Surgery, however, cannot remove the entire calcification because the lump is soft and spongy. Even with surgical removal, calcifications commonly recur. In some cases, scleroderma resolves on its own, but the changes to the skin remain.
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Scleroderma Foundation http://www.scleroderma.org/medical/other_articles/griffing_2003_2_calcinosis.shtm
National Institutes of Health: National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov/Health_Info/Scleroderma/default.asp
University of Maryland Medical Center http://www.umm.edu/altmed/articles/scleroderma-000147.htm
The Merck Manual http://www.merck.com/mmhe/sec05/ch068/ch068c.html