What is the current medical opinion with regard to the treatment of calcinosis in cases of scleroderma. In particular what are the risks and benefits of surgical intervention?
Treatment is difficult but there are a few anecdotal suggestions such as low dose warfarin, probenecid and colchicine which are used in gout, calcium channel blockers such as diltiazem, intralesional corticosteroids, carbon dioxide lasers and anti-TNF therapies used in rheumatoid arthritis. Recently reported in the Annals of Rheumatic Disease were 9 patients treated with Minocycline an antibiotic. Minocycline was shown to be beneficial to the removal of calcinosis as well as its other properties. This was given in cyclical doses. But the side effects limited its usage. A well tried method particularly for many patients with calcinosis of the fingers is waxing (as mentioned above). This softens the skin and allows natural extrusion of the calcium. One must always resist the temptation to ‘pick’ at these lesions as this leads to skin infection and then the need to proceed further with oral antibiotics. Surgical techniques that are well tried include removal with the aid of a dental drill
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