Four different patterns of dystrophic calcinosis have been described in patients with juvenile dermatomyositis: superficial plaques or nodules, deep nodular deposits that extend to the muscles, deposits along fascial planes of the muscles and tendons, and an extensive hard calcium deposit that covers the entire surface of the body. The sites frequently affected are the elbows, knees, digits, and extremities. It is believed that calcium salt deposits occur with severe juvenile dermatomyositis cases with persistent inflammation. Macrophages and proinflammatory cytokines have been observed in calcium fluids.2 Treatment is based on anecdotal reports.3 Bisphosphonates are a potentially promising approach through inhibition of calcium hydroxyapatite formation, macrophage function, and bone calcium resorption.4 Surgical removal is indicated for patients experiencing chronic pain, loss of function, infections, or nonhealing ulcers. Potential complications of surgery include problems with wound healing and recurrence.5 This tends to be uncommon with good control of the dermatomyositis before undertaking surgery; use of low doses of corticosteroids to minimize disruption to wound healing; and minimization of surgical trauma, avoiding healing by secondary intention. In conclusion, surgical resection with attention to detail with concomitant specific medical therapy is recommended for treatment of gluteal calcinosis in juvenile dermatomyositis.
Agata Vitale, M.D., Ph.D.
Gabriele Delia, M.D., Ph.D.
Francesco La Torre, M.D.
Policlinico G. Martino
The authors received no support from any company or community for preparation of this article.
1. Feldman BM, Rider LG, Reed AM, Pachman LM. Juvenile dermatomyositis and other idiopathic inflammatory myopathies of childhood. Lancet
2. Marhaug G, Shah V, Shroff R, et al. Age-dependent inhibition of ectopic calcification: A possible role for fetuin-A and osteopontin in patients with juvenile dermatomyositis with calcinosis. Rheumatology (Oxford)
3. Riley P, McCann LJ, Maillard SM, Woo P, Murray KJ, Pilkington CA. Effectiveness of infliximab in the treatment of refractory juvenile dermatomyositis with calcinosis. Rheumatology (Oxford)
4. Ambler GR, Chaitow J, Rogers M, McDonald DW, Ouvrier RA. Rapid improvement of calcinosis in juvenile dermatomyositis with alendronate therapy. J Rheumatol
5. Kerstein MD. The non-healing leg ulcer: Peripheral vascular disease, chronic venous insufficiency, and ischemic vasculitis. Ostomy Wound Manage
. 1995;42(10A Suppl):19S–35S.
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