Late-onset calcinosis in burn scars: A review of the literature and two case reports.

Calcinosis cutis is a heterotopic accumulation of calcium salts in the skin. It has been described as a late-onset complication of burn scars in a few cases, in contrast to heterotopic ossification, which may be an early-onset complication of burn injuries. Diagnosis of calcinosis can be confirmed by radiography, ultrasonography, computed tomography, magnetic resonance imaging or histology. Almost all cases of late-onset calcinosis in burn scars present as non-healing ulcers on the lower extremities near contracture bands. It has been hypothesized that this localization is due to the more frequent microtrauma of the lower extremities, and that ulceration is due to the presence of calcium deposits as foreign bodies. In our study, the mean age at the time of burn injury was 12.5 ± 8.27 years, and calcinosis developed after a mean time of 37.5 ± 14.95 years (mean age at onset was 50.5 ± 14.53 years). There was no significant difference between burn scars managed with skin grafting and those where skin grafting was not carried out. The ulcers healed after resection or extraction of the deposits without any recurrence at the same site. In contrast to previously reported cases, we observed two cases of non-ulcerating late-onset calcinosis in burn scars of the upper extremities.