LAUSR

A 70-year-old woman with amyopathic dermatomyositis presented with 20 years of progressive, painful subcutaneous nodules in the trunk and extremities. The nodules would occasionally ulcerate, expelling an off-white material (Fig. 1a, b). Skin biopsy was compatible with calcinosis cutis. Computed tomography scout film showed diffusely distributed thick calcifications in her subcutaneous tissue (Fig. 1c). Calcinosis cutis (CC) is a syndrome characterized by calcium salt deposition in the skin and hypodermis. CC can be divided into five types: dystrophic (the most common type), calciphylaxis, iatrogenic, idiopathic, and metastatic. Dystrophic CC results from local tissue damage, which creates an optimal environment for calcification. Association with connective tissue diseases is common, especially dermatomyositis and systemic sclerosis. Dystrophic CC may also be seen with cutaneous neoplasms, infections, or trauma. Serum calcium and phosphorus levels are typically normal. Diagnosis may be suspected upon physical findings (firm papules or nodules, that ulcerate or extrude chalky white-yellow material), skin biopsy (demonstrating calcium in the dermis or subcutis by von Kossa tissue stain), or imaging (x-ray, CT, and MRI). The patient was treated with oral methotrexate, minocycline, aluminum hydroxide, and topical 25% sodium metabisulfite cream. After 6 months, the pain, erythema, and the size of calcifications had improved.