Calcinosis Cutis

Dystrophic Calcinosis Cutis associated with Dermatomyositis.

What would you propose as therapeutic option in this case?

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.

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.

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.

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 .

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.

Toxicodermia caused by diltiazem.

Calcinosis Cutis associated with Dermatomyositis.

Treatment was prescribed without improvement in 2007-2008:

Elevation of prednisone dose. Diphosphonates (alendronate). Colchicine. Aluminum hydroxide. Hydroxychloroquine.

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?

Dystrophic Calcinosis Cutis associated with Dermatomyositis.

What would you propose as therapeutic option in this case?