Disorders of Calcium Homoeostasis
- Hypoparathyroidism and Impetigo Herpetiformis
Impetigo herpetiformis is related to hypoparathyroidism and hypocalcaemia in late pregnancy. Polycyclic oedematous red patches, bordered by tiny pustules in herpetiform distribution start in the flexures and disseminate centripetally. Older patches dry and form colerette-like scales. Histopathologically, intraepidermal Kogoj macropustules originating from migration of neutrophils into higher levels of the epidermis are observed.
The clinical and histological feature are indistinguishable from those of psoriasis pustulosa. Treatment success with systemic and topical glucocorticoids, ciclosporine, and methotrexate as well as with etretinate has been described.
Hyperparathyroidism may present with generalized pruritus. If patients with secondary hyperparathyreoidism and pruritus in terminal renal insufficiency underwent total parathyroidectomy, pruritus disappeared within few days after surgery.
Calcinosis cutis designates localized deposits of calcium salts in the skin. They appear as yellow-white, adamant tumours within the skin. Milia-like calcinosis cutis, occurring in patients with Down syndrome, and tumourous calcinosis may be discriminated. Treatment by sodium sulphate or cellulose phosphate and intralesional triamcinolone have been proposed. In some cases, surgical interventions is advisable.
Calciphylaxis occurs nearly exclusively in secondary hyperparathyroidism in chronic renal insufficiency. It is a life-threatening condition, characterized by livid-reddish and painful necrotic lesions, and localized on finger tips, around the thighs, ankles, buttocks or trunk. They may progress to deep necrotic lesions and heal with massive scarring. In histopathology, deposits of calcium in the walls of subendothelial small blood vessels are visible. As treatment, parathyroidectomy is advisable.
KeywordsDown Syndrome Secondary Hyperparathyroidism Chronic Renal Insufficiency Pustular Psoriasis Total Parathyroidectomy
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