Calciphylaxis and nephrogenic systemic fibrosis are rapidly progressive diseases associated with renal impairment with high rates of mortality and morbidity. In this review, we highlight the role of the dermatologist in the multispecialty team approach to the diagnosis, treatment, and management of these patients. We present sample cases from our hospital practice to emphasize the importance of diagnosis, clinicopathologic correlation, rapid intervention, and treatment of these challenging skin disorders.