title: Intralesional sodium thiosulfate for the treatment of calciphylaxis.
abstract: OBJECTIVE
  Calciphylaxis is a potentially fatal disorder of abnormal calcium deposition. Patients commonly present with painful retiform to stellate purpuric lesions that often undergo ulceration and necrosis, increasing the risk of infection and life-threatening sepsis. Treatment is multifaceted, and improved outcomes have been demonstrated with intravenous sodium thiosulfate; however, the use of this medication can be limited by its adverse effects. The use of topical sodium thiosulfate has been successfully reported for superficial calcium deposits in the skin from other processes. Therefore, we hypothesized that intralesional (IL) sodium thiosulfate may be an effective treatment for the deeper lesions of cutaneous calciphylaxis. We provide a retrospective case review of 4 patients with calciphylaxis who were treated with IL sodium thiosulfate.
  
  
  METHODS
  Four patients with biopsy-proven cutaneous calciphylaxis were treated with IL sodium thiosulfate (250 mg/mL) in areas of clinically active disease. The patients tolerated the medication well, with only transient localized discomfort during injection. All 4 patients had complete healing of their ulcers and remission of disease.
  
  
  CONCLUSIONS
  Intralesional sodium thiosulfate may be an effective and well-tolerated treatment for localized calciphylaxis. This novel approach requires further research and investigation.
authors.affiliation: Department of Dermatology, Massachusetts General Hospital, Boston.
authors.forename: Lauren
authors.initials: L
authors.lastname: Strazzula
authors.forename: Sagar U
authors.initials: SU
authors.lastname: Nigwekar
authors.forename: David
authors.initials: D
authors.lastname: Steele
authors.forename: William
authors.initials: W
authors.lastname: Tsiaras
authors.forename: Meghan
authors.initials: M
authors.lastname: Sise
authors.forename: Sabina
authors.initials: S
authors.lastname: Bis
authors.forename: Gideon P
authors.initials: GP
authors.lastname: Smith
authors.forename: Daniela
authors.initials: D
authors.lastname: Kroshinsky
mesh_terms: D000368:Aged; D002115:Calciphylaxis / Q000188:drug therapy* / Q000473:pathology; D002614:Chelating Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D013885:Thiosulfates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D002614:Chelating Agents; D013885:Thiosulfates; C017717:sodium thiosulfate