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QJM: An International Journal of Medicine, 2016, 753

doi: 10.1093/qjmed/hcw138
Advance Access Publication Date: 9 August 2016
Clinical picture


Calcinosis cutis universalis

A 67-year-old woman was presented in our dermatologic outpa- described surgical excision is for most patients an effective
tient clinic. She reported that for at least two decades her skin be- option.3 Finally, it is most important to diagnose the associated
come erythematous with a slight itching and a progressively or underlying systemic diseases to enable a causative
hardening over her body. In the last months some ulcerations of treatment.
the skin arose and she developed severe pain. At both hands, she
had violaceous papules overlying the metacarpal and interpha- Financial support information
langeal joints and periungual teleangiectasias. The clinical im- The authors confirm that they have not received any financial
pressive findings were verified by X-ray diagnostics and computer support or other benefits from commercial sources for the work
tomography as generalized subcutaneous calcifications without reported on in the manuscript.
abnormal bone calcification (Figure 1). Serological we found
amongst others massive elevated antinuclear antibodies (ANA) Photographs and text from: A. Körber and J. Dissemond,
and positive anti-Jo-1 antibodies. Taken together the serological Department of Dermatology, University School of Medicine
and histopathological results we diagnosed a calcinosis cutis uni- Essen, Hufelandstr. 55, 45122 Essen, Germany.
versalis because of an underlying dermatomyositis and started a email:
systemic treatment with azathioprine.
Calcinosis cutis is a rare condition characterized by the de-
position of calcium phosphate (hydroxyapatite) crystals in the
skin in various areas of the body. This calcinosis cutis can be 1. Lee CC, Yang YH, Chiang BL. Calcinosis universalis
associated with normal or elevated calcium levels. Minimally complicating juvenile dermatomyositis. Arthritis Rheum 2005;
intense calcinosis cutis is a frequent symptom seen in patients 52:1626.
with scleroderma CREST syndrome, lupus erythematosus, over- 2. Man J, Kalisiak M, Birchall IW, Salopek TG. Chronic cutaneous
lap syndromes or dermatomyosistis.1 Likewise the rarely graft-versus-host disease manifesting as calcinosis cutis uni-
described calcinosis cutis universalis is mostly associated with versalis on a background of widespread sclerodermatoid
collagenoses but even other diseases like graft-versus-host can changes. J Cutan Med Surg 2010; 14:249–53.
be rare causes.2 Pathophysiologically, it can be divided into dys- 3. Cousins MA, Jones DB, Whyte MP, Monafo WW. Surgical man-
trophic, metastatic and idiopathic types. Even if successful agement of calcinosis cutis universalis in systemic lupus ery-
therapies, for example, with probenecid, diltiazem, wafarin alu- thematosus. Arthritis Rheum 1997; 40: 570-2.
minum hydroxide, colchicine or bisphosphonates had been

Figure 1. A 67-year-old woman with dermatomyositis-induced calcinosis cutis universalis; (a) clinical findings and (b) X-ray findings of the upper part of the body.

C The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.
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