Calcinosis represents a severe complication of several autoimmune disorders. Soft-tissue calcifications have been classified into five major types: dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis. Autoimmune diseases are usually associated with dystrophic calcifications, including calcinosis cutis, occurring in damaged or devitalized tissues in the presence of normal serum levels of calcium and phosphate. In particular, calcinosis cutis has been described in dermatomyositis, polymyositis, juvenile dermatomyositis, systemic sclerosis, systemic lupus erythematosus, primary Sjögren’s syndrome, overlap syndrome, mixed connective tissue disease, and rheumatoid arthritis. Calciphylaxis, a severe and life-threatening syndrome presenting with vascular calcifications and thrombosis, has also been associated with some autoimmune conditions. Due to the potentially disabling character of calcinosis cutis and calciphylaxis, physicians’ awareness about the clinical presentation and management of these diseases should be increased to select the most appropriate treatment option and avoid long-term complications. In this review, we aim to analyze the clinical features of calcinosis cutis and calciphylaxis associated with autoimmune diseases, and the main treatment strategies evaluated up to now for treating this potentially disabling disease.

Carbon peel laser treatment has been described for the improvement of skin texture, with pore reduction and acne lesion treatment. The technique consists of applying a carbon mask to the face for about ten minutes followed by laser irradiation with a Q-switched 1064 nm laser. This mechanism of action seems to be related to small carbon molecules binding both the corneocytes and serum within the hair follicles; the effect of the laser eliminates carbon bound to skin particles and the high temperature generated reduces sebum production by sebaceous glands and inhibits Cutibacterium acnes replication. Although this method was described 20 years ago, scientific data supporting its efficacy and safety have only recently been reported in small case series. For this reason, we performed a retrospective study including patients treated from January to May 2022 in the context of a private practice. Even if this study is limited by the low number of patients and its retrospective nature, this is the first research to show that carbon peel laser, performed with a standardized technique, is an effective and safe treatment for patients with acne lesions, showing pores and wrinkles, and is able to improve the overall skin aspect.

Background: Carbon-assisted, Q-switched, neodymium-doped yttrium-aluminum-garnet laser treatment consists of applying a topical carbon suspension all over the face, followed by irradiation with a Q-switched 1064-nm neodymium-doped yttrium-aluminum-garnet laser. The delivery of multiple microdroplets of dilute onabotulinum toxin type A into the dermis has been investigated as a tool for facial rejuvenation. The aim of this study was to assess the effectiveness of the combined treatment with botulinum toxin and carbon peel laser (performed with a standardized technique) in patients with seborrhea, dilated pores, and wrinkles, and to demonstrate its benefits in improving the overall skin aspect. Methods: Patients enrolled in this prospective pilot study underwent 3 sessions of the combined treatment carried out 3 months apart. To evaluate the improvement of skin texture, wrinkles, dilated pores, and acne lesions, the Fitzpatrick Wrinkle Assessment Scale, the Physician Global Aesthetic Improvement Scale, a photographic scale for the pore assessment, and the Investigator Global Assessment of Acne scale were used. The FACE-Q was also administered to assess patient satisfaction. The scores obtained were compared using a paired t test. Results: Twenty patients were recruited. The differences between pretreatment and posttreatment scores were statistically significant (P < 0.05) on the Fitzpatrick Wrinkle Assessment Scale, Physician Global Aesthetic Improvement Scale, Investigator Global Assessment of Acne scale, FACE-Q, and photographic scale for the pore assessment. Conclusions: This combined protocol could be considered as a useful tool to treat skin flaws that affect texture, microroughness, and seborrhea and to reduce the size of enlarged pores. Its versatility allows for customized treatment with minimal discomfort to patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.