78 y/o AA with Polymyositis and RA maintained on immuran and prdnisone c painful subcutaneous nodules; 2 of which have ulcerated. Bx shows subcutaneous fat necrosis with calcification. neg for AFB and fungal elements. She has had these nodules come and go for some years. The skin above is more pigmented than her surrounding skin. No fevers, chills, sweats. no other major constitutional s/s. no responding (in fact enlarging) to standard moist occlusive dressing and excisional debridement. She also has CKD stage 3, never has been on dialysis. Also have DM, A1c obese