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Management of refractory cutaneous dermatomyositis

Ruth Ann Vleugels, MD, MPH
Section Editor
Jeffrey Callen, MD, FACP, FAAD
Deputy Editor
Abena O Ofori, MD


Classic dermatomyositis (DM) is an idiopathic inflammatory myopathy that most commonly presents with progressive, symmetric proximal muscle weakness and a group of characteristic cutaneous findings. The cutaneous manifestations of DM may also develop in the absence of detectable muscle disease, and can persist after the successful treatment of DM-associated myositis.

Skin lesions of DM are often resistant to photoprotection and topical therapies alone, necessitating the initiation of systemic therapy. Patients who fail to respond to antimalarials and methotrexate, or who relapse during therapy with these agents require more aggressive immunosuppressive or immunomodulatory drugs.

The management of patients with refractory cutaneous DM will be discussed here. The initial treatment of cutaneous DM, as well as the clinical manifestations, diagnosis, and management of the extracutaneous manifestations of DM and juvenile DM are reviewed elsewhere. (See "Initial management of cutaneous dermatomyositis" and "Clinical manifestations of dermatomyositis and polymyositis in adults" and "Diagnosis and differential diagnosis of dermatomyositis and polymyositis in adults" and "Initial treatment of dermatomyositis and polymyositis in adults" and "Treatment of recurrent and resistant dermatomyositis and polymyositis in adults" and "Juvenile dermatomyositis and polymyositis: Epidemiology, pathogenesis, and clinical manifestations" and "Juvenile dermatomyositis and polymyositis: Treatment, complications, and prognosis".)


DM is associated with characteristic cutaneous findings, most notably a pruritic, violaceous to erythematous eruption involving the scalp face, neck, upper trunk, arms, and dorsal hands (picture 1A-F). Pruritus associated with DM can be severe, leading to significant detrimental effects on patient quality of life. (See "Clinical manifestations of dermatomyositis and polymyositis in adults", section on 'Skin findings' and "Initial management of cutaneous dermatomyositis", section on 'Classification of cutaneous DM'.)

For a subset of patients with skin manifestations of DM, trials of multiple therapies (in combination or sequentially) are required to identify the treatment regimen that produces satisfactory disease control. Because many patients fail to improve adequately with photoprotection, antipruritics, and topical corticosteroids or topical calcineurin inhibitors, the addition of systemic antimalarials or methotrexate is often necessary. Patients who fail to respond to these conventional interventions or who relapse after an initial response require the initiation of more aggressive therapies. (See "Initial management of cutaneous dermatomyositis", section on 'Treatment'.)


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Literature review current through: Sep 2016. | This topic last updated: Apr 28, 2016.
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  1. Majithia V, Harisdangkul V. Mycophenolate mofetil (CellCept): an alternative therapy for autoimmune inflammatory myopathy. Rheumatology (Oxford) 2005; 44:386.
  2. Rowin J, Amato AA, Deisher N, et al. Mycophenolate mofetil in dermatomyositis: is it safe? Neurology 2006; 66:1245.
  3. Tausche AK, Meurer M. Mycophenolate mofetil for dermatomyositis. Dermatology 2001; 202:341.
  4. Ytterberg SR. Treatment of refractory polymyositis and dermatomyositis. Curr Rheumatol Rep 2006; 8:167.
  5. Gelber AC, Nousari HC, Wigley FM. Mycophenolate mofetil in the treatment of severe skin manifestations of dermatomyositis: a series of 4 cases. J Rheumatol 2000; 27:1542.
  6. Edge JC, Outland JD, Dempsey JR, Callen JP. Mycophenolate mofetil as an effective corticosteroid-sparing therapy for recalcitrant dermatomyositis. Arch Dermatol 2006; 142:65.
  7. Suzuki Y, Hayakawa H, Miwa S, et al. Intravenous immunoglobulin therapy for refractory interstitial lung disease associated with polymyositis/dermatomyositis. Lung 2009; 187:201.
  8. Lang BA, Laxer RM, Murphy G, et al. Treatment of dermatomyositis with intravenous gammaglobulin. Am J Med 1991; 91:169.
  9. Cherin P, Herson S, Wechsler B, et al. Efficacy of intravenous gammaglobulin therapy in chronic refractory polymyositis and dermatomyositis: an open study with 20 adult patients. Am J Med 1991; 91:162.
  10. Mastaglia FL, Phillips BA, Zilko PJ. Immunoglobulin therapy in inflammatory myopathies. J Neurol Neurosurg Psychiatry 1998; 65:107.
  11. Al-Mayouf SM, Laxer RM, Schneider R, et al. Intravenous immunoglobulin therapy for juvenile dermatomyositis: efficacy and safety. J Rheumatol 2000; 27:2498.
  12. Sansome A, Dubowitz V. Intravenous immunoglobulin in juvenile dermatomyositis--four year review of nine cases. Arch Dis Child 1995; 72:25.
  13. Kampylafka EI, Kosmidis ML, Panagiotakos DB, et al. The effect of intravenous immunoglobulin (IVIG) treatment on patients with dermatomyositis: a 4-year follow-up study. Clin Exp Rheumatol 2012; 30:397.
  14. Dalakas MC, Illa I, Dambrosia JM, et al. A controlled trial of high-dose intravenous immune globulin infusions as treatment for dermatomyositis. N Engl J Med 1993; 329:1993.
  15. Peake MF, Perkins P, Elston DM, et al. Cutaneous ulcers of refractory adult dermatomyositis responsive to intravenous immunoglobulin. Cutis 1998; 62:89.
  16. Barbasso Helmers S, Dastmalchi M, Alexanderson H, et al. Limited effects of high-dose intravenous immunoglobulin (IVIG) treatment on molecular expression in muscle tissue of patients with inflammatory myopathies. Ann Rheum Dis 2007; 66:1276.
  17. Sadayama T, Miyagawa S, Shirai T. Low-dose intravenous immunoglobulin therapy for intractable dermatomyositis skin lesions. J Dermatol 1999; 26:457.
  18. Dalakas MC. The role of high-dose immune globulin intravenous in the treatment of dermatomyositis. Int Immunopharmacol 2006; 6:550.
  19. Callen JP. Immunomodulatory treatment for dermatomyositis. Curr Allergy Asthma Rep 2008; 8:348.
  20. Konohana A, Kawashima J. Successful treatment of dermatomyositis with dapsone. Clin Exp Dermatol 1994; 19:367.
  21. Cohen JB. Cutaneous involvement of dermatomyositis can respond to Dapsone therapy. Int J Dermatol 2002; 41:182.
  22. Flores-Suárez LF, Morales H, Angeles A, Kraus A. Drug-induced amyopathic dermatomyositis. J Clin Rheumatol 2002; 8:50.
  23. Boswell JS, Costner MI. Leflunomide as adjuvant treatment of dermatomyositis. J Am Acad Dermatol 2008; 58:403.
  24. Sontheimer RD. The management of dermatomyositis: current treatment options. Expert Opin Pharmacother 2004; 5:1083.
  25. Rios Fernández R, Callejas Rubio JL, Sánchez Cano D, et al. Rituximab in the treatment of dermatomyositis and other inflammatory myopathies. A report of 4 cases and review of the literature. Clin Exp Rheumatol 2009; 27:1009.
  26. Noss EH, Hausner-Sypek DL, Weinblatt ME. Rituximab as therapy for refractory polymyositis and dermatomyositis. J Rheumatol 2006; 33:1021.
  27. Chiappetta N, Steier J, Gruber B. Rituximab in the treatment of refractory dermatomyositis. J Clin Rheumatol 2005; 11:264.
  28. Gottenberg JE, Guillevin L, Lambotte O, et al. Tolerance and short term efficacy of rituximab in 43 patients with systemic autoimmune diseases. Ann Rheum Dis 2005; 64:913.
  29. Lambotte O, Kotb R, Maigne G, et al. Efficacy of rituximab in refractory polymyositis. J Rheumatol 2005; 32:1369.
  30. Kaposztas Z, Etheridge WB, Kahan BD. Case report: successful treatment of posttransplant lymphoproliferative disorder and quiescence of dermatomyositis with rituximab and sirolimus. Transplant Proc 2008; 40:1744.
  31. Touma Z, Arayssi T, Kibbi L, Masri AF. Successful treatment of cardiac involvement in dermatomyositis with rituximab. Joint Bone Spine 2008; 75:334.
  32. Feist E, Dörner T, Sörensen H, Burmester GR. Longlasting remissions after treatment with rituximab for autoimmune myositis. J Rheumatol 2008; 35:1230.
  33. Dinh HV, McCormack C, Hall S, Prince HM. Rituximab for the treatment of the skin manifestations of dermatomyositis: a report of 3 cases. J Am Acad Dermatol 2007; 56:148.
  34. Oddis CV, Reed AM, Aggarwal R, et al. Rituximab in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis: a randomized, placebo-phase trial. Arthritis Rheum 2013; 65:314.
  35. Levine TD. Rituximab in the treatment of dermatomyositis: an open-label pilot study. Arthritis Rheum 2005; 52:601.
  36. Cooper MA, Willingham DL, Brown DE, et al. Rituximab for the treatment of juvenile dermatomyositis: a report of four pediatric patients. Arthritis Rheum 2007; 56:3107.
  37. Chung L, Genovese MC, Fiorentino DF. A pilot trial of rituximab in the treatment of patients with dermatomyositis. Arch Dermatol 2007; 143:763.
  38. Hellerstedt B, Ahmed A. Delayed-type hypersensitivity reaction or serum sickness after rituximab treatment. Ann Oncol 2003; 14:1792.
  39. Lueck CJ, Trend P, Swash M. Cyclosporin in the management of polymyositis and dermatomyositis. J Neurol Neurosurg Psychiatry 1991; 54:1007.
  40. Grau JM, Herrero C, Casademont J, et al. Cyclosporine A as first choice therapy for dermatomyositis. J Rheumatol 1994; 21:381.
  41. Qushmaq KA, Chalmers A, Esdaile JM. Cyclosporin A in the treatment of refractory adult polymyositis/dermatomyositis: population based experience in 6 patients and literature review. J Rheumatol 2000; 27:2855.
  42. Vencovský J, Jarosová K, Machácek S, et al. Cyclosporine A versus methotrexate in the treatment of polymyositis and dermatomyositis. Scand J Rheumatol 2000; 29:95.
  43. Reiff A, Rawlings DJ, Shaham B, et al. Preliminary evidence for cyclosporin A as an alternative in the treatment of recalcitrant juvenile rheumatoid arthritis and juvenile dermatomyositis. J Rheumatol 1997; 24:2436.
  44. Heckmatt J, Hasson N, Saunders C, et al. Cyclosporin in juvenile dermatomyositis. Lancet 1989; 1:1063.
  45. Kim HJ, Hong YK, Yoo WH. Dermatomyositis, complicated with pneumomediastinum, successfully treated with cyclosporine A: a case report and review of literature. Rheumatol Int 2009; 29:1101.
  46. Ochi S, Nanki T, Takada K, et al. Favorable outcomes with tacrolimus in two patients with refractory interstitial lung disease associated with polymyositis/dermatomyositis. Clin Exp Rheumatol 2005; 23:707.
  47. Wilkes MR, Sereika SM, Fertig N, et al. Treatment of antisynthetase-associated interstitial lung disease with tacrolimus. Arthritis Rheum 2005; 52:2439.
  48. Ando M, Miyazaki E, Yamasue M, et al. Successful treatment with tacrolimus of progressive interstitial pneumonia associated with amyopathic dermatomyositis refractory to cyclosporine. Clin Rheumatol 2010; 29:443.
  49. Mitsui T, Kuroda Y, Kunishige M, Matsumoto T. Successful treatment with tacrolimus in a case of refractory dermatomyositis. Intern Med 2005; 44:1197.
  50. Mok CC, To CH, Szeto ML. Successful treatment of dermatomyositis-related rapidly progressive interstitial pneumonitis with sequential oral cyclophosphamide and azathioprine. Scand J Rheumatol 2003; 32:181.
  51. Meyer O, Hayem G, Palazzo E, et al. Interstitial lung disease due to polymyositis or dermatomyositis: effect of a 6-month course of i.v. pulse cyclophosphamide. Clin Exp Rheumatol 2005; 23:724.
  52. Takashi S, Okubo Y, Yamazaki Y, et al. [Amyopathic dermatomyositis with interstitial pneumonia: effective treatment with cyclophosphamide pulse therapy]. Nihon Kokyuki Gakkai Zasshi 1999; 37:647.
  53. Yamasaki Y, Yamada H, Yamasaki M, et al. Intravenous cyclophosphamide therapy for progressive interstitial pneumonia in patients with polymyositis/dermatomyositis. Rheumatology (Oxford) 2007; 46:124.
  54. Sinoway PA, Callen JP. Chlorambucil. An effective corticosteroid-sparing agent for patients with recalcitrant dermatomyositis. Arthritis Rheum 1993; 36:319.
  55. Cagnoli M, Marchesoni A, Tosi S. Combined steroid, methotrexate and chlorambucil therapy for steroid-resistant dermatomyositis. Clin Exp Rheumatol 1991; 9:658.
  56. Wallace DJ, Metzger AL, White KK. Combination immunosuppressive treatment of steroid-resistant dermatomyositis/polymyositis. Arthritis Rheum 1985; 28:590.
  57. Nadiminti U, Arbiser JL. Rapamycin (sirolimus) as a steroid-sparing agent in dermatomyositis. J Am Acad Dermatol 2005; 52:17.
  58. Tsujimura S, Saito K, Tanaka Y. Complete resolution of dermatomyositis with refractory cutaneous vasculitis by intravenous cyclophosphamide pulse therapy. Intern Med 2008; 47:1935.
  59. Hassan J, van der Net JJ, van Royen-Kerkhof A. Treatment of refractory juvenile dermatomyositis with tacrolimus. Clin Rheumatol 2008; 27:1469.
  60. Martín Nalda A, Modesto Caballero C, Arnal Guimeral C, et al. [Efficacy of tacrolimus (FK-506) in the treatment of recalcitrant juvenile dermatomyositis: study of 6 cases]. Med Clin (Barc) 2006; 127:697.
  61. Yamada A, Ohshima Y, Omata N, et al. Steroid-sparing effect of tacrolimus in a patient with juvenile dermatomyositis presenting poor bioavailability of cyclosporine A. Eur J Pediatr 2004; 163:561.
  62. Shimojima Y, Ishii W, Kato T, et al. Intractable skin necrosis and interstitial pneumonia in amyopathic dermatomyositis, successfully treated with cyclosporin A. Intern Med 2003; 42:1253.
  63. Hengstman G, van den Hoogen, van Engelen B, et al. Anti-TNF blockage with infliximab (Remicade) in polymyositis and dermatomyositis. Arthritis Rheum 2000; 43:S193.
  64. Norman R, Greenberg RG, Jackson JM. Case reports of etanercept in inflammatory dermatoses. J Am Acad Dermatol 2006; 54:S139.
  65. Selva-O'Callaghan A, Martínez-Costa X, Solans-Laque R, et al. Refractory adult dermatomyositis with pneumatosis cystoides intestinalis treated with infliximab. Rheumatology (Oxford) 2004; 43:1196.
  66. Sprott H, Glatzel M, Michel BA. Treatment of myositis with etanercept (Enbrel), a recombinant human soluble fusion protein of TNF-alpha type II receptor and IgG1. Rheumatology (Oxford) 2004; 43:524.
  67. Korkmaz C, Temiz G, Cetinbas F, Büyükkidan B. Successful treatment of alveolar hypoventilation due to dermatomyositis with anti-tumour necrosis factor-alpha. Rheumatology (Oxford) 2004; 43:937.
  68. Efthimiou P, Schwartzman S, Kagen LJ. Possible role for tumour necrosis factor inhibitors in the treatment of resistant dermatomyositis and polymyositis: a retrospective study of eight patients. Ann Rheum Dis 2006; 65:1233.
  69. Riley P, McCann LJ, Maillard SM, et al. Effectiveness of infliximab in the treatment of refractory juvenile dermatomyositis with calcinosis. Rheumatology (Oxford) 2008; 47:877.
  70. Miller M, Mendez E, Klein-Gitelman M. Use of etanercept in juvenile dermatomyositis. Arthritis Rheum 2002; 46:S306.
  71. Saddeh CK. Entanercept is effective in the treatment of polymyositis/dermatomyositis which is refractory to conventional therapy including steroids and other disease modifying agents. Arthritis Rheum 2000; 43:S193.
  72. Nzeusseu A, Durez P, Houssiau H, Devogelaer J. Successful use of infliximab in a case of refractory juvenile dermatomyositis. Arthritis Rheum 2000; 43:S193.
  73. Dold S, Justiniano ME, Marquez J, Espinoza LR. Treatment of early and refractory dermatomyositis with infliximab: a report of two cases. Clin Rheumatol 2007; 26:1186.
  74. Dastmalchi M, Grundtman C, Alexanderson H, et al. A high incidence of disease flares in an open pilot study of infliximab in patients with refractory inflammatory myopathies. Ann Rheum Dis 2008; 67:1670.
  75. Iannone F, Scioscia C, Falappone PC, et al. Use of etanercept in the treatment of dermatomyositis: a case series. J Rheumatol 2006; 33:1802.
  76. Hengstman GJ, De Bleecker JL, Feist E, et al. Open-label trial of anti-TNF-alpha in dermato- and polymyositis treated concomitantly with methotrexate. Eur Neurol 2008; 59:159.
  77. Flendrie M, Vissers WH, Creemers MC, et al. Dermatological conditions during TNF-alpha-blocking therapy in patients with rheumatoid arthritis: a prospective study. Arthritis Res Ther 2005; 7:R666.
  78. Hall HA, Zimmermann B. Evolution of dermatomyositis during therapy with a tumor necrosis factor alpha inhibitor. Arthritis Rheum 2006; 55:982.
  79. Klein R, Rosenbach M, Kim EJ, et al. Tumor necrosis factor inhibitor-associated dermatomyositis. Arch Dermatol 2010; 146:780.
  80. Sangle VS, Sangle SR, D'Cruz DP. Leflunomide as a remission-maintaining therapy in difficult-to-treat dermatomyositis. Ann Rheum Dis 2008; 67:723.
  81. Sebastiani M, Puccini R, Manfredi A, et al. Staphylococcus protein A-based extracorporeal immunoadsorption and thalidomide in the treatment of skin manifestation of dermatomyositis: a case report. Ther Apher Dial 2009; 13:225.
  82. Sereda D, Werth VP. Improvement in dermatomyositis rash associated with the use of antiestrogen medication. Arch Dermatol 2006; 142:70.
  83. Hornung T, Janzen V, Heidgen FJ, et al. Remission of recalcitrant dermatomyositis treated with ruxolitinib. N Engl J Med 2014; 371:2537.
  84. Kurtzman DJ, Wright NA, Lin J, et al. Tofacitinib Citrate for Refractory Cutaneous Dermatomyositis: An Alternative Treatment. JAMA Dermatol 2016; 152:944.
  85. Kelly JJ, Madoc-Jones H, Adelman LS, et al. Response to total body irradiation in dermatomyositis. Muscle Nerve 1988; 11:120.
  86. Holzer U, van Royen-Kerkhof A, van der Torre P, et al. Successful autologous stem cell transplantation in two patients with juvenile dermatomyositis. Scand J Rheumatol 2010; 39:88.
  87. Saccardi R, Di Gioia M, Bosi A. Haematopoietic stem cell transplantation for autoimmune disorders. Curr Opin Hematol 2008; 15:594.
  88. Wu FQ, Luan Z, Lai JM, et al. [Treatment of refractory rheumatism among preschool children with autologous peripheral blood hematopoietic stem cell transplantation]. Zhonghua Er Ke Za Zhi 2007; 45:809.
  89. Oryoji K, Himeji D, Nagafuji K, et al. Successful treatment of rapidly progressive interstitial pneumonia with autologous peripheral blood stem cell transplantation in a patient with dermatomyositis. Clin Rheumatol 2005; 24:637.
  90. Tsukamoto H, Nagafuji K, Horiuchi T, et al. A phase I-II trial of autologous peripheral blood stem cell transplantation in the treatment of refractory autoimmune disease. Ann Rheum Dis 2006; 65:508.
  91. van Laar JM, Tyndall A. Adult stem cells in the treatment of autoimmune diseases. Rheumatology (Oxford) 2006; 45:1187.
  92. Tyndall A, Passweg J, Gratwohl A. Haemopoietic stem cell transplantation in the treatment of severe autoimmune diseases 2000. Ann Rheum Dis 2001; 60:702.
  93. Pachman LM. Juvenile dermatomyositis: decreased calcinosis with intermittent high-dose intravenous methylprednisolone therapy. Arthritis Rheum 1994; 37:429.
  94. Fisler RE, Liang MG, Fuhlbrigge RC, et al. Aggressive management of juvenile dermatomyositis results in improved outcome and decreased incidence of calcinosis. J Am Acad Dermatol 2002; 47:505.
  95. Bowyer SL, Blane CE, Sullivan DB, Cassidy JT. Childhood dermatomyositis: factors predicting functional outcome and development of dystrophic calcification. J Pediatr 1983; 103:882.
  96. Pachman LM, Hayford JR, Chung A, et al. Juvenile dermatomyositis at diagnosis: clinical characteristics of 79 children. J Rheumatol 1998; 25:1198.
  97. Miller LC, Michael AF, Kim Y. Childhood dermatomyositis. Clinical course and long-term follow-up. Clin Pediatr (Phila) 1987; 26:561.
  98. Shehata R, al-Mayouf S, al-Dalaan A, et al. Juvenile dermatomyositis: clinical profile and disease course in 25 patients. Clin Exp Rheumatol 1999; 17:115.
  99. Al-Mayouf S, Al-Mazyed A, Bahabri S. Efficacy of early treatment of severe juvenile dermatomyositis with intravenous methylprednisolone and methotrexate. Clin Rheumatol 2000; 19:138.
  100. Shahani L. Refractory calcinosis in a patient with dermatomyositis: response to intravenous immune globulin. BMJ Case Rep 2012; 2012.
  101. Matsuoka Y, Miyajima S, Okada N. A case of calcinosis universalis successfully treated with low-dose warfarin. J Dermatol 1998; 25:716.
  102. Harel L, Harel G, Korenreich L, et al. Treatment of calcinosis in juvenile dermatomyositis with probenecid: the role of phosphorus metabolism in the development of calcifications. J Rheumatol 2001; 28:1129.
  103. Wang WJ, Lo WL, Wong CK. Calcinosis cutis in juvenile dermatomyositis: remarkable response to aluminum hydroxide therapy. Arch Dermatol 1988; 124:1721.
  104. Mukamel M, Horev G, Mimouni M. New insight into calcinosis of juvenile dermatomyositis: a study of composition and treatment. J Pediatr 2001; 138:763.
  105. Ambler GR, Chaitow J, Rogers M, et al. Rapid improvement of calcinosis in juvenile dermatomyositis with alendronate therapy. J Rheumatol 2005; 32:1837.
  106. Downey EC Jr, Woolley MM, Hanson V. Required surgical therapy in the pediatric patient with dermatomyositis. Arch Surg 1988; 123:1117.
  107. Wu JJ, Metz BJ. Calcinosis cutis of juvenile dermatomyositis treated with incision and drainage. Dermatol Surg 2008; 34:575.
  108. Chan AY, Li E. Electric shock wave lithotripsy (ESWL) as a pain control measure in dermatomyositis with calcinosis cutis-old method, new discovery. Clin Rheumatol 2005; 24:172.
  109. Abdallah-Lotf M, Grasland A, Vinceneux P, Sigal-Grinberg M. Regression of cutis calcinosis with diltiazem in adult dermatomyositis. Eur J Dermatol 2005; 15:102.
  110. Oliveri MB, Palermo R, Mautalen C, Hübscher O. Regression of calcinosis during diltiazem treatment in juvenile dermatomyositis. J Rheumatol 1996; 23:2152.
  111. Vinen CS, Patel S, Bruckner FE. Regression of calcinosis associated with adult dermatomyositis following diltiazem therapy. Rheumatology (Oxford) 2000; 39:333.
  112. Marco Puche A, Calvo Penades I, Lopez Montesinos B. Effectiveness of the treatment with intravenous pamidronate in calcinosis in juvenile dermatomyositis. Clin Exp Rheumatol 2010; 28:135.
  113. Slimani S, Abdessemed A, Haddouche A, Ladjouze-Rezig A. Complete resolution of universal calcinosis in a patient with juvenile dermatomyositis using pamidronate. Joint Bone Spine 2010; 77:70.
  114. Fuchs D, Fruchter L, Fishel B, et al. Colchicine suppression of local inflammation due to calcinosis in dermatomyositis and progressive systemic sclerosis. Clin Rheumatol 1986; 5:527.
  115. Al-Mayouf SM, Alsonbul A, Alismail K. Localized calcinosis in juvenile dermatomyositis: successful treatment with intralesional corticosteroids injection. Int J Rheum Dis 2010; 13:e26.
  116. Schanz S, Ulmer A, Fierlbeck G. Response of dystrophic calcification to intravenous immunoglobulin. Arch Dermatol 2008; 144:585.
  117. Peñate Y, Guillermo N, Melwani P, et al. Calcinosis cutis associated with amyopathic dermatomyositis: response to intravenous immunoglobulin. J Am Acad Dermatol 2009; 60:1076.
  118. Shearin JC, Pickrell K. Surgical treatment of subcutaneous calcifications of polymyositis or dermatomyositis. Ann Plast Surg 1980; 5:381.