Dermatomyositis — SCE Dermatology MCQ

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ModerateConnective Tissue & VasculitisDermatomyositisSCE Dermatology

A 42-year-old woman with dermatomyositis has developed calcinosis cutis. She has firm subcutaneous calcium deposits on her elbows and fingertips causing pain and skin breakdown. What type of calcinosis is this?

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Correct answer: E — Dystrophic calcification

Calcinosis cutis in dermatomyositis is classified as dystrophic calcification — calcium deposition in damaged/inflamed tissue with NORMAL serum calcium and phosphate levels. It is particularly common in juvenile dermatomyositis (up to 40%) and is associated with delayed diagnosis and inadequate initial treatment. Metastatic calcification occurs with abnormal calcium/phosphate metabolism (CKD, hyperparathyroidism). Calciphylaxis is a distinct entity of arteriolar calcification with thrombosis seen in CKD. Treatment of dystrophic calcinosis is challenging; options include Diltiazem, Colchicine, Minocycline, Sodium thiosulfate (IV or topical), and surgical excision of symptomatic deposits.

Reference: BAD 2016 DM Guidelines; EULAR 2017