Treatment of calcinosis cutis in systemic sclerosis and dermatomyositis: A review of the literature

Abstract

We have limited data on the treatment of calcinosis cutis associated with systemic sclerosis and dermatomyositis. To assess the efficacy and tolerance of available treatments for calcinosis cutis based on previously published studies. We performed a systematic review of studies published in Medline, Embase, and the Cochrane library during 1980-July 2018. The strength of clinical data was graded according to the modified Oxford Centre for Evidence-Based Medicine levels of evidence. In all, 30 studies (288 patients) were included. Eleven therapeutic classes, surgery, and physical treatments were identified as potential treatment options for calcinosis cutis. On the basis of results of a small randomized controlled trial and 4 retrospective studies, low-dose warfarin should not be used for calcinosis cutis (level IB evidence). The results of several studies suggest diltiazem and bisphosphonates might be useful treatment options (level IV). Considering biologic therapies, rituximab has shown promising results in treating both dermatomyositis and systemic sclerosis, whereas tumor necrosis factor inhibitors might be useful for treating juvenile dermatomyositis (level IV). Intralesional sodium thiosulfate might be a promising alternative (level IV). Few included studies had a high level of evidence. This study highlights the efficacy and tolerance profiles of available treatments for calcinosis cutis, with a focus on level of evidence.