Calcinosis Cutis in Juvenile Dermatomyositis: Remarkable Response to Aluminum Hydroxide Therapy

Wang, Wen-Jen

doi:10.1001/archderm.1988.01670110077022

Cited by 80 publications

(23 citation statements)

References 4 publications

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“…These properties are thought to lead to a decrease in the calcification reaction as phosphorus is sequestered into aluminum salts (45). Aluminum hydroxide interacts with phosphorus, becoming aluminum phosphate, and decreases phosphorus absorption in the intestine.…”

Section: Intravenous Immunoglobulin (Ivig)mentioning

confidence: 99%

Calcinosis cutis in autoimmune connective tissue diseases

2012

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Calcinosis cutis is a chronic condition involving insoluble calcified deposits of the skin and subcutaneous tissue. It is commonly associated with autoimmune connective tissue diseases and can be a source of pain and functional disability. The likelihood of developing calcinosis varies among the autoimmune connective tissue diseases, with systemic sclerosis and dermatomyositis being the most commonly associated. Identification of therapy for this challenging disorder has been hampered by a paucity of large controlled trials. Although there is no uniformly effective treatment for calcinosis cutis, several surgical and medical therapies have demonstrated varying degrees of benefit in the treatment of calcinosis, including surgical excision, laser therapy, extracorporeal shock wave lithotripsy, diltiazem, minocycline, colchicine, and topical sodium thiosulfate, along with others. Recommendations for the diagnosis and therapy of calcinosis cutis in patients with autoimmune connective tissue diseases are discussed.

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Section: Intravenous Immunoglobulin (Ivig)mentioning

confidence: 99%

Calcinosis cutis in autoimmune connective tissue diseases

2012

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“…However, as the number of patients is limited, the recommendation level was reduced to C1 on the basis of consensus of the committee. Also, there are case reports concerning aluminum hydroxide gel, diltiazem hydrochloride, probenecid and bisphosphonate preparations, and the evidence level is V for all. As for surgical treatment, there are only expert opinions, and the evidence level is VI. Recently, the incidence of cutaneous calcinosis is considered to be decreasing due to early steroid administration for the primary disease.…”

Section: Cq14: What Treatments Are Useful For Cutaneous Calcinosis Inmentioning

confidence: 99%

“…From these results, warfarin is expected to be effective for small lesions of calcification that have appeared recently (see CQ12). There are also a number of reports that oral administration of aluminum hydroxide gel was useful for the control of calcinosis in children with dermatomyositis . Aluminum hydroxide is considered to prevent calcium deposition by forming insoluble aluminum phosphate, reducing intestinal absorption of phosphorus, thus reducing the formation of calcium phosphate in blood Diltiazem hydrochloride may suppress calcium deposition by preventing the influx of Ca ion into cells, and there are case reports suggesting its usefulness …”

Section: Cq14: What Treatments Are Useful For Cutaneous Calcinosis Inmentioning

confidence: 99%

The wound/burn guidelines – 4: Guidelines for the management of skin ulcers associated with connective tissue disease/vasculitis

Fujimoto

Asano

Ishii

et al. 2016

The Journal of Dermatology

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The Japanese Dermatological Association prepared guidelines focused on the treatment of skin ulcers associated with connective tissue disease/vasculitis practical in clinical settings of dermatological care. Skin ulcers associated with connective tissue diseases or vasculitis occur on the background of a wide variety of diseases including, typically, systemic sclerosis but also systemic lupus erythematosus (SLE), dermatomyositis, rheumatoid arthritis (RA), various vasculitides and antiphospholipid antibody syndrome (APS). Therefore, in preparing the present guidelines, we considered diagnostic/therapeutic approaches appropriate for each of these disorders to be necessary and developed algorithms and clinical questions for systemic sclerosis, SLE, dermatomyositis, RA, vasculitis and APS.Key words: antiphospholipid antibody syndrome, dermatomyositis, rheumatoid arthritis, systemic lupus erythematosus, vasculitis.Correspondence: Hironobu Ihn, M.D., Ph.D., Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan. Email: ihn-der@kumamoto-u.ac.jp This is the secondary English version of the original Japanese manuscript for The wound/burn guidelines -4: Guidelines for the management of skin ulcers associated with connective tissue disease/vasculitis published in

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“…Management recommendations are based upon case reports and case series, as no controlled trials have been reported. [17,[72][73][74] The uricosuric agent probenecid (250 mg day) has also been effective in several individual cases, [75][76][77][78] ostensibly by increasing renal phosphate clearance. As discussed in section 2.2.3, prevention of calcinosis by early treatment with systemic corticosteroids has not been adequately addressed in prospective trials.…”

Section: Management Of Calcinosismentioning

confidence: 99%

Juvenile-Onset Clinically Amyopathic Dermatomyositis

Walling¹,

Gerami

Sontheimer

2010

Pediatric Drugs

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Juvenile-onset amyopathic dermatomyositis is an uncommon variant of juvenile-onset dermatomyositis (JDM), characterized by the hallmark cutaneous features of dermatomyositis for at least 6 months without clinical or laboratory evidence of muscle disease. Cutaneous calcinosis, vasculopathy, and interstitial lung disease frequently complicate the course of classic JDM (typical JDM with myositis) but are infrequent in amyopathic JDM. Recent literature suggests that approximately 75% of amyopathic JDM patients will remain free from muscle disease after years of follow-up, while approximately 25% of patients will evolve to having classic JDM. No clinical, laboratory, or ancillary parameters have been found to be predictive for this transition to muscle disease. Treatment of the cutaneous disease of amyopathic JDM centers on photoprotection and topical therapies directed against inflammation. Oral antimalarials are effective for cutaneous disease not adequately controlled with topical care. Systemic corticosteroids, while central to the treatment of classic JDM, are controversial in the treatment of amyopathic JDM. Randomized controlled trials are not available to guide the management of this disease. Proponents for early aggressive systemic corticosteroid therapy for amyopathic JDM advocate that this intervention may decrease the likelihood of progression to classic JDM, and/or prevent disease-specific complications of JDM such as calcinosis. Opponents of early intervention with systemic corticosteroids favor expectant management directed toward controlling skin disease, citing the predictable adverse effects of systemic corticosteroids in the face of uncertain benefit. Other therapeutic options for severe and recalcitrant cutaneous disease, including methotrexate, intravenous immunoglobulin, and rituximab, are reviewed, as are treatment options for calcinosis cutis. In weighing the available evidence, the authors conclude that early aggressive treatment of amyopathic JDM with systemic immunosuppressant agents should be avoided in most cases as the risk of these medications will outweigh the measurable benefit. The reported literature suggests a good prognosis for amyopathic JDM. Ongoing clinical follow-up is recommended in all cases to allow early detection of subtle signs of muscle disease.

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Calcinosis Cutis in Juvenile Dermatomyositis: Remarkable Response to Aluminum Hydroxide Therapy

Cited by 80 publications

References 4 publications

Calcinosis cutis in autoimmune connective tissue diseases

Calcinosis cutis in autoimmune connective tissue diseases

The wound/burn guidelines – 4: Guidelines for the management of skin ulcers associated with connective tissue disease/vasculitis

Juvenile-Onset Clinically Amyopathic Dermatomyositis

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