From the Guidelines
Treatment for calcinosis cutis in dermatomyositis should prioritize a combination of approaches, including calcium channel blockers, bisphosphonates, and immunosuppressants, with a focus on reducing inflammation and preventing further calcinosis development, as supported by the most recent evidence 1.
Key Considerations
- The underlying dermatomyositis should be aggressively treated with immunosuppressants like methotrexate, mycophenolate mofetil, or rituximab to prevent further calcinosis development.
- First-line treatments may include calcium channel blockers like diltiazem and bisphosphonates such as alendronate or pamidronate.
- Topical sodium thiosulfate can dissolve calcium deposits and may be considered for localized lesions.
- Surgical excision, carbon dioxide laser therapy, or extracorporeal shock wave lithotripsy might be considered for localized lesions.
Treatment Approach
- The treatment approach should be individualized and may require combination therapy.
- The pathophysiology of calcinosis cutis involves dystrophic calcification in damaged tissue, with calcium and phosphate precipitating in an alkaline environment.
- Treatment is often prolonged and may require ongoing management to prevent further calcinosis development.
Evidence-Based Recommendations
- The most recent evidence 1 suggests that there is limited evidence to guide clinicians on the treatment of calcinosis cutis in dermatomyositis.
- However, a combination of approaches, including calcium channel blockers, bisphosphonates, and immunosuppressants, may be effective in reducing inflammation and preventing further calcinosis development.
- Topical sodium thiosulfate and other non-pharmacological treatments, such as carbon dioxide laser therapy, may also be considered.
From the FDA Drug Label
- Collagen Diseases During an exacerbation or as maintenance therapy in selected cases of: Systemic lupus erythematosus Systemic dermatomyositis (polymyositis) Acute rheumatic carditis
- Dermatomyositis treatment may include prednisone, as it is indicated for systemic dermatomyositis (polymyositis) during an exacerbation or as maintenance therapy in selected cases.
- However, calcinosis cutis is not explicitly mentioned in the drug label as an indication for prednisone treatment.
- Therefore, based on the provided information, no conclusion can be drawn regarding the use of prednisone for the treatment of calcinosis cutis in dermatomyositis 2
From the Research
Treatment Options for Calcinosis Cutis in Dermatomyositis
- The treatment of calcinosis in dermatomyositis remains a challenge, with few descriptions in the literature of low scientific evidence 3.
- Available pharmacologic therapies for calcinosis include those targeting calcium and phosphorus metabolism, immunosuppressive/anti-inflammatory therapies, and vasodilators 4.
- Mounting evidence supports the use of various formulations of sodium thiosulfate in the treatment of calcinosis, including intralesional injections with platelet-rich plasma (PRP) 4, 5.
- Minocycline can be useful, particularly for lesions associated with surrounding inflammation 4.
- Powerful vasodilators, such as prostacyclin analogs, may have promise in the treatment of calcinosis, but further studies are necessary 4.
- Surgical removal of lesions is a treatment option when amenable 4, 6.
- Intravenous immunoglobulin (IVIG) infusions in combination with prednisone may also be an effective treatment method, although standardization and additional research are required 5.
- JAK inhibitors appear to be a newer promising therapy in juvenile dermatomyositis, although more research is needed 6.
Key Considerations
- Early diagnosis and controlling the overall disease activity are crucial to prevent calcinosis in juvenile dermatomyositis 6.
- Prolonged state of inflammation and features of vascular dysfunction are associated with calcinosis 6.
- Neutrophil activation and mitochondrial dysfunction have recently emerged as potential mechanistic pathways involved in calcinosis pathogenesis 6.