Should Calcium Supplementation be Abandoned in Patients With Calcinosis Cutis?

Abstract

Calcinosis cutis, characterized by the pathological deposition of insoluble calcium salts in the skin, is associated with several disease entities, particularly autoimmune conditions such as scleroderma and dermatomyositis. Lesions of calcinosis are often painful, prone to ulceration, and significantly impair quality of life. Despite the clinical impact, no effective treatments have been established to date, making prevention of this condition a critical priority. In this narrative review, we explore the evidence suggesting that calcium supplementation may contribute to skin calcification. Calcium supplements have been demonstrated to transiently elevate plasma calcium levels, potentially promoting dystrophic tissue calcification-a process that may be exacerbated in a context of magnesium and vitamin K2 deficiencies. Furthermore, calcium supplementation has been associated with an increased risk of adverse cardiovascular events; this concern is particularly relevant in patients with autoimmune diseases who already face elevated cardiovascular comorbidity. Notably, there is no robust evidence supporting the efficacy of calcium supplementation in preventing osteoporosis. Instead, sufficient dietary intake of calcium and protein, along with the supplementation of micronutrients critical for calcium homeostasis (magnesium, zinc, vitamin D₃, and vitamin K₂), should be considered as alternatives to calcium supplementation.