Calcinosis Cutis

Calcinosis cutis in patients with dermatomyositis

1. Dystrophic Calcinosis
Cutis associated with
Dermatomyositis.
What would you propose as
therapeutic option in this case?

2. Calcinosis Cutis associated with
Dermatomyositis.
54-year-old women.
Diagnosed of Dermatomyositis in 2005.
Currently in remission after treatment with
prednisone and azathioprine.
The patient was referred for evaluation because
of multiple, firm nodules of the lumbosacral
region and right hip since 2006.
She have begun to cause incapacitation pain
and many exude a yellowish material suggestive
of calcium.

3. Calcinosis Cutis associated with
Dermatomyositis.
Physical examination
•Calcic nodules coalesced to form a stony
consistency plaques on the right hip.
•In some areas ulcerated lesions exuded
yellowish material.

4. Calcinosis Cutis associated with
Dermatomyositis.
Laboratory examinations:
Normal serum calcium, inorganic phosphate,
and alkaline phosphatase.
The calcium-phosphate product was 42mg/dl
(N <70mg/dl).
Parathyroid hormone, vitamin D, and renal
function were within normal range.

5. Calcinosis Cutis associated with
Dermatomyositis.
Skin Biopsy revealed:
Epidermal hyperkeratotic and acanthosis and
massive dystrophic calcium deposits in the
subcutaneous tissue.
Radiographs confirmed calcic depositions
in soft tissues .

8. Calcinosis Cutis associated with
Dermatomyositis
In 2006, diltiazem was started and
gradually increased to 120 mg a day, but
had to be suspended for toxicodermia
caused by diltiazem.

9. Toxicodermia caused by diltiazem.

11. Calcinosis Cutis associated with
Dermatomyositis.
Treatment was prescribed without
improvement in 2007-2008:
Elevation of prednisone dose.
Diphosphonates (alendronate).
Colchicine.
Aluminum hydroxide.
Hydroxychloroquine.

12. Calcinosis Cutis associated with
Dermatomyositis.
•It has recently been published an article
which proposes gammaglobilina
intravenous therapy.
Calcinosis cutis associated with amyopathic dermatomyositis:
response to intravenous immunoglobulin. J Am Acad Dermatol.
2009 Jun;60(6):1076-7.
•What is your opinion about this treatment
option?

13. Dystrophic Calcinosis
Cutis associated with
Dermatomyositis.
What would you propose as
therapeutic option in this case?