QJM: An International Journal of Medicine, 2016, 753
doi: 10.1093/qjmed/hcw138
CLINICAL PICTURE
Calcinosis cutis universalis
A 67-year-old woman was presented in our dermatologic outpa-
tient clinic. She reported that for at least two decades her skin be-
come erythematous with a slight itching and a progressively
hardening over her body. In the last months some ulcerations of
the skin arose and she developed severe pain. At both hands, she
had violaceous papules overlying the metacarpal and interpha-
langeal joints and periungual teleangiectasias. The clinical im-
pressive findings were verified by X-ray diagnostics and computer
tomography as generalized subcutaneous calcifications without
abnormal bone calcification (Figure 1). Serological we found
amongst others massive elevated antinuclear antibodies (ANA)
and positive anti-Jo-1 antibodies. Taken together the serological
and histopathological results we diagnosed a calcinosis cutis uni-
versalis because of an underlying dermatomyositis and started a
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
associated with normal or elevated calcium levels. Minimally
intense calcinosis cutis is a frequent symptom seen in patients
with scleroderma CREST syndrome, lupus erythematosus, over-
lap syndromes or dermatomyosistis.1 Likewise the rarely
described calcinosis cutis universalis is mostly associated with
collagenoses but even other diseases like graft-versus-host can
be rare causes.2 Pathophysiologically, it can be divided into dys-
trophic, metastatic and idiopathic types. Even if successful
therapies, for example, with probenecid, diltiazem, wafarin alu-
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.
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Clinical picture
described surgical excision is for most patients an effective
option.3 Finally, it is most important to diagnose the associated
or underlying systemic diseases to enable a causative
treatment.
Financial support information
The authors confirm that they have not received any financial
support or other benefits from commercial sources for the work
reported on in the manuscript.
Photographs and text from: A. Körber and J. Dissemond,
Department of Dermatology, University School of Medicine
Essen, Hufelandstr. 55, 45122 Essen, Germany.
email: joachim.dissemond@uk-essen.de
References
1. Lee CC, Yang YH, Chiang BL. Calcinosis universalis
complicating juvenile dermatomyositis. Arthritis Rheum 2005;
52:1626.
2. Man J, Kalisiak M, Birchall IW, Salopek TG. Chronic cutaneous
graft-versus-host disease manifesting as calcinosis cutis uni-
versalis on a background of widespread sclerodermatoid
changes. J Cutan Med Surg 2010; 14:249–53.
3. Cousins MA, Jones DB, Whyte MP, Monafo WW. Surgical man-
agement of calcinosis cutis universalis in systemic lupus ery-
thematosus. Arthritis Rheum 1997; 40: 570-2.
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