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Granja BV, De Matos PR, Azevedo F, Baudrier T, Mota A. Intralesional sodium thiosulfate for the treatment of calciphylaxis: a case report and review of the literature. Int J Dermatol 2024; 63:132-134. [PMID: 37919830 DOI: 10.1111/ijd.16894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/13/2023] [Accepted: 10/22/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Bárbara V Granja
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro R De Matos
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Filomena Azevedo
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Teresa Baudrier
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Alberto Mota
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de São João, Porto, Portugal
- RISE@ CINTESIS, Faculty of Medicine, Porto University, Porto, Portugal
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Tubau C, Cubiró X, Amat-Samaranch V, Garcia-Melendo C, Puig L, Roé-Crespo E. Clinical and ultrasonography follow-up of five cases of calcinosis cutis successfully treated with intralesional sodium thiosulfate. J Ultrasound 2022; 25:995-1003. [PMID: 35397096 PMCID: PMC9705646 DOI: 10.1007/s40477-022-00665-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/17/2022] [Indexed: 10/18/2022] Open
Abstract
Calcinosis cutis (CC) is characterized by deposit of calcium salts in the skin and subcutaneous tissue; its clinical presentation consists of indurated painful nodules, which can ulcerate and become superinfected. CC treatment remains a challenge, yet successful treatment with intralesional (IL) sodium thiosulfate (STS) has been reported in several CC subtypes. Herein we are reporting on a case series of 5 patients with CC successfully treated with IL-STS. We describe the 18-22 MHz ultrasound characteristics of the lesions and on follow-up after treatment. Ultrasound imaging was useful in guiding IL-STS injections and confirming response to treatment.
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Affiliation(s)
- Carla Tubau
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain.
| | - Xavier Cubiró
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
| | - Victoria Amat-Samaranch
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
| | - Cristina Garcia-Melendo
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
| | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
| | - Esther Roé-Crespo
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
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López-Sundh AE, Quintana-Sancho A, Durán-Vian C, Reguero-DelCura L, Corrales-Martínez AF, Gómez-Fernández C, González-López MA. Clinical and ultrasound response to intralesional sodium thiosulfate for the treatment of calcinosis cutis in the setting of systemic sclerosis. A case-based review. Clin Rheumatol 2020; 40:2985-2989. [PMID: 33244722 DOI: 10.1007/s10067-020-05523-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Calcinosis cutis (CC) is defined as the deposition of calcium salts on the skin and subcutaneous tissue. It is associated with different conditions, including some autoimmune diseases, and it can generate significant inflammation, pain, and functional impairment. Different therapies have been tried with limited results. Intralesional sodium thiosulfate seems a promising therapeutic option. We report a patient with diffuse systemic sclerosis who presented with two symmetrical plaques on both axillae, which caused pain and skin retraction. The clinical diagnosis was consistent with CC, which was confirmed by skin biopsy and ultrasound. The patient was treated with a 250 mg/ml solution of sodium thiosulfate injected into the plaques. Complete resolution was achieved after three monthly sessions. The only reported adverse effect was a transient burning sensation during the injections. Given its effectiveness and safety, we believe that intralesional sodium thiosulfate could become a valid first-line option for the treatment of CC.
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Affiliation(s)
| | - A Quintana-Sancho
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - C Durán-Vian
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - L Reguero-DelCura
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A F Corrales-Martínez
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - C Gómez-Fernández
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M A González-López
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Darrieurtort-Laffite C, Bertrand-Vasseur A, Garraud T, Planche L, Le Goff B. Tolerance and effect of sodium thiosulfate in calcific tendinitis of the rotator cuff. Clin Rheumatol 2019; 39:561-569. [PMID: 31673978 DOI: 10.1007/s10067-019-04793-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Calcific tendinitis of the rotator cuff is one of the most common causes of shoulder pain. Ultrasound-guided percutaneous lavage of calcific tendinopathy is performed when conservative treatments have failed. Sodium thiosulfate (STS) has recently been used with success in the treatment of tumoral calcinosis. The goal of this phase II study was to assess the tolerance and the feasibility of STS lavage of calcific tendinopathy. METHODS We included patient with type hard calcifications. Patients were treated with puncture and lavage followed by injection of STS in the calcification. VAS pain at rest and during activities, ultrasound, and X-ray were evaluated at 1 week and 1 and 3 months. RESULTS Seventeen patients were included. Baseline VAS at rest and during daily activities was a mean 40.2 ± 25.9 and 65.5 ± 21.6 respectively. All patients underwent the entire procedure with no adverse event. Calcium backflow could be obtained in 15 patients (88.2%). Five patients (30%) had more than 50% decrease of their calcific deposit size at 1 month and 8 (47%) patients at 3 months. VAS pain during activities and at rest decreased significantly at 3 months (p = 0.0004; p = 0.001). Efficacy would be demonstrated if 60% of the patients had more than 50% decrease size of their calcification CONCLUSION: Overall, STS was well tolerated with no side effect occurring during the procedure and the follow-up. However, no significant effect on calcium disappearance could be demonstrated compared with what is expected without STS. New studies using larger volume and repeated injections of STS are now needed. CLINICAL TRIAL REGISTRATION NUMBER NCT02538939Key Points• Lavage of calcific tendinopathy of the rotator cuff with sodium thiosulfate is feasible• No adverse events have been observed after or in the 3 months after the procedure• We could not demonstrate that sodium thiosulfate increases the chance of calcium disappearance• New studies using larger volume and repeated injections of STS are needed to further explore the interest of sodium thiosulfate in the treatment of calcific tendinopathy.
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Affiliation(s)
- C Darrieurtort-Laffite
- Rheumatology Department, Hôtel-Dieu, Nantes, France.,INSERM UMR1238, Bone Sarcoma and Remodeling of Calcified Tissue, Nantes, France
| | | | - T Garraud
- Rheumatology Department, Hôtel-Dieu, Nantes, France
| | - L Planche
- Biometrics and Statistic Platform, Hôtel-Dieu, Nantes, France
| | - B Le Goff
- Rheumatology Department, Hôtel-Dieu, Nantes, France. .,INSERM UMR1238, Bone Sarcoma and Remodeling of Calcified Tissue, Nantes, France.
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Galassi A, Perna F, De Nicola E, Moneghini L, Sganzaroli AB, Cozzolino M. Calciphylaxis in a dialysis patient treated by intralesional and systemic sodium thiosulphate on top of multifactorial intervention. Clin Kidney J 2019; 12:546-549. [PMID: 31384447 PMCID: PMC6671482 DOI: 10.1093/ckj/sfy119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Indexed: 11/14/2022] Open
Abstract
Calciphylaxis, or calcific uraemic arteriolopathy (CUA), represents a life-threatening disease. Dialysis patients and those receiving warfarin are seen as populations at higher risk for CUA. Treatments for CUA are still uncertain despite the poor survival of the disease. Administration of intravenous sodium thiosulphate (STS) has been purposed to treat CUA in dialysis patients. Due to the poor tolerability of STS, characterized by nausea, hypocalcaemia, metabolic acidosis and QT-interval prolongation, its intralesional administration has been reported. We herein present the improvement of wounds in a haemodialysis patient affected by CUA, treated by multipronged intervention including both intravenous and intralesional STS.
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Affiliation(s)
- Andrea Galassi
- Health Sciences, Renal Division, University of Milan, San Paolo Hospital, Milan, Italy
- Renal & Dialysis Unit, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Francesco Perna
- Renal & Dialysis Unit, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Enrico De Nicola
- Hepato-Biliary-Pancreatic and Digestive Surgery Unit, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - Laura Moneghini
- Unit of Pathology, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - Adriana B Sganzaroli
- Gruppo Multimedica, Diabetic Foot Center, S. Giuseppe Hospital, Multimedica, Milan, Italy
| | - Mario Cozzolino
- Health Sciences, Renal Division, University of Milan, San Paolo Hospital, Milan, Italy
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García-Lozano JA, Ocampo-Candiani J, Martínez-Cabriales SA, Garza-Rodríguez V. An Update on Calciphylaxis. Am J Clin Dermatol 2018; 19:599-608. [PMID: 29808451 DOI: 10.1007/s40257-018-0361-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Calciphylaxis, also known as calcific uremic arteriolopathy and uremic small artery disease with medial wall calcification and intimal hyperplasia, is a multifactorial cutaneous vascular disease characterized by chronic, painful, non-healing wounds that occur frequently in patients with chronic kidney disease, predominantly in those with end-stage renal disease. The pathogenesis remains unclear, and the development of calciphylaxis lesions depends on medial calcification, intimal fibrosis of arterioles and thrombotic occlusion. Despite an increase in reports of calciphylaxis in the literature and clinical recognition of demographic characteristics and risk factors associated with calciphylaxis, it remains a poorly understood disease with high morbidity and mortality. In this review, we analyze and summarize the clinical manifestations, pathogenesis and pathophysiology, histopathology, differential diagnosis, diagnostic workup and treatment modalities for calciphylaxis. Because of the lack of consensus regarding the optimal approach to and treatment of this disorder, a high degree of clinical suspicion, early diagnosis, and multimodal and multidisciplinary treatment in collaboration with dermatology, nephrology, wound care, nutrition and pain management specialties may improve survival in patients with calciphylaxis.
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Abstract
PURPOSE OF REVIEW Calciphylaxis remains a poorly understood vascular calcification disorder with predilection for patients with end-stage renal disease (ESRD). Recent data from large patient registries and databases have begun to provide information regarding incidence, risk factors, and outcomes in patients with calciphylaxis. RECENT FINDINGS The most recent estimate places the incidence of calciphylaxis at 3.5 new cases/1000 patient-years among the patients with ESRD on chronic hemodialysis. It is possible that misdiagnosis or subclinical disease may attribute to lower than the true incidence. There is a suggestion that the incidence is higher in peritoneal dialysis patients compared with patients with hemodialysis. Recent studies have identified a number of risk factors and point to the effects of vitamin K deficiency mediated impairment in Matrix Gla Protein carboxylation as one of the likely pathogenic mechanisms. The outcomes in calciphylaxis patients remain poor with mortality approaching 30% at 6 months and 50% at 12 months. SUMMARY The present review describes recent literature in the field of calciphylaxis. Calciphylaxis registries and specimen biorepositories promise to provide insights into the pathogenesis of calciphylaxis and will pave the way for much needed clinical trials.
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Schroeder RJ, Audlin J, Luo J, Nicholas BD. Pharmacokinetics of sodium thiosulfate in Guinea pig perilymph following middle ear application. J Otol 2018; 13:54-58. [PMID: 30559765 PMCID: PMC6291635 DOI: 10.1016/j.joto.2017.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/29/2017] [Accepted: 12/05/2017] [Indexed: 11/17/2022] Open
Abstract
Hypothesis To determine the pharmacokinetics of sodium thiosulfate in the inner ear perilymph following middle ear application in Guinea pigs. Background Cisplatin chemotherapy is often associated with a dose-dependent high frequency sensorineural hearing loss. Sodium thiosulfate has been shown to reduce cisplatin-induced ototoxicity when given intravenously, but this may limit the tumoricidal effects of the chemotherapy. Recent animal studies looking at middle ear application of sodium thiosulfate have shown prevention of outer hair cell and hearing loss, but the perilymph pharmacokinetics have not yet been established. Methods Twenty Guinea pig ears were split into two groups and administered sodium thiosulfate to the middle ear at either a concentration of 250 mg/mL or 50 mg/mL for 30 min. Perilymph samples were then obtained serially through the round window over 6 h. Sodium thiosulfate concentrations were obtained using high-pressure liquid chromatography. Results The 250 mg/mL group had a maximum perilymph concentration of 7.27 mg/mL (±0.83) that decreased to 0.94 mg/mL (±0.03) over 6 h. The 50 mg/mL group had an initial concentration of 1.63 mg/mL (±0.17) and was undetectable after 1 h. The half-life of sodium thiosulfate within perilymph was 0.74 h. Conclusions and Relevance: The results of this study show that sodium thiosulfate is capable of diffusing through round window and into the inner ear perilymph. Peak levels decline over several hours after exposure. This has a potential application as a localized therapy in the prevention of cisplatin induced ototoxicity.
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Isoherranen K, Bouchard L, Kluger N. Benefits of intralesional injections of sodium thiosulfate in the treatment of calciphylaxis. Int Wound J 2017; 14:955-959. [PMID: 28326673 DOI: 10.1111/iwj.12738] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/06/2017] [Accepted: 02/10/2017] [Indexed: 11/28/2022] Open
Abstract
Calciphylaxis (CPX) is a rare calcifying thrombotic vasculopathy responsible for painful necrotic ulcers, with a high mortality rate, and its management is often difficult. Recently, intravenous infusions of sodium thiosulfate (STS) have shown efficacy. The aim of this study was to assess the efficacy of intralesional STS (IL STS) in four patients. Our aim was to assess the efficacy of IL STS in a prospective mono-centric open study that included four patients with a biopsy-proven cutaneous CPX. Four women (55-84 years old, mean age: 71·2 years) with a uremic (n = 1) or non-uremic CPX (n = 3) and primary hyperparathyroidism induced by teriparatide or after the initiation of oral anti-vitamin K were treated by IL STS (250 mg/ml). The injections were performed around the ulcers, on the active borders, once or twice a week and then at 1-2 weeks intervals. The injected quantity varied from 1·5 to 15 ml. Pain usually improved after two series of injections. Clinical response was visible after 2 weeks. Three patients (75%) healed completely or almost completely. A failure was observed in the last patient who also had lower limb arteriopathy. The main side effect was the pain during injections. IL STS is an interesting alternative therapeutic option in the management of CPX necrotic ulcers with limited side effects. Larger studies are warranted to precisely define its place, its administration procedure and the patients who could benefit from it.
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Affiliation(s)
- Kirsi Isoherranen
- Department of Dermatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Laura Bouchard
- Department of Dermatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Nicolas Kluger
- Department of Dermatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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