Calcinosis Cutis Occurring in Association With Autoimmune Connective Tissue Disease The Mayo Clinic Experience With 78 Patients, 1996-2009

Objective: To describe characteristics and treatment of patients with calcinosis cutis in the clinical setting of autoimmune connective tissue disease (ACTD). Design: Retrospective study. Setting: Tertiary referral center. Patients: Seventy-eight patients with calcinosis cutis and ACTD between 1996 and 2009. Main Outcome Measures: Clinical features, treatments, and outcomes of patients with calcinosis cutis in the clinical setting of ACTD. Results: Of 78 patients (mean age at onset of calcinosis cutis, 40.1 years), 64 (82%) were female. The following diseases were associated with calcinosis cutis: dermatomyositis (n=30) with classic (n=15), juvenile (n=14), and amyopathic (n=1) subtypes; systemic sclerosis with limited cutaneous scleroderma (n=24); lupus panniculitis (n=4); systemic lupus erythematosus (n=2); mixed connective tissue disease (n=4); overlap connective tissue disease (n=6); undifferentiated connective tissue disease (n=6); polymyositis (n=1); and rheumatoid arthritis (n=1). Therapy for calcinosis cutis consisted of medical treatment alone (n=19), surgical therapy alone (n=11), combined medical and surgical treatment (n=17), no treatment (n=30), and unknown (n=1). Diltiazem hydrochloride was the most commonly used medical therapy, with 9 of 17 patients having a partial response. Twenty-eight patients had surgical excision of 1 or more lesions of calcinosis cutis: 22 had a complete response, 5 had a partial response, and 1 had no response. Conclusions: Dermatomyositis and systemic sclerosis were the most common ACTDs associated with calcinosis cutis. Although no treatment was uniformly effective, surgical excision of symptomatic lesions and medical treatment with diltiazem provided benefit for some patients.