Topical Sodium Thiosulfate Therapy for Leg Ulcers With Dystrophic Calcification

Abstract

The Cutting Edge: Challenges in Medical and Surgical Therapeutics REPORT OF A CASEA 41-year-old African American woman with a 14-year history of systemic lupus erythematosus (SLE) presented with exquisitely painful stellate ulcers with surrounding livedo reticularis on both shins in April 2006. In addition to smallvessel involvement, her connective tissue disease was characterized by pulmonary fibrosis, pulmonary hypertension requiring continuous oxygen supplementation, Raynaud phenomenon,andchronicrightpoplitealdeepvenousthrombosis. Her medications included prednisone (5 mg/d), methotrexate (12.5 mg/wk), folic acid, hydroxychloroquine, pentoxyphilline, coumadin, budesonide inhaler, fluticasone inhaler, fexofenadine, erythropoietin, sildenafil, amlodipine, gabapentin, acetaminophen-codeine, tramadol hydrochloride, famciclovir, tolterodine, calcium supplement, vitamin E supplement, alendronate, and esomeprazole. The results of laboratory tests were remarkable for the following values: hemoglobin, 8.8 g/dL (to convert to grams per liter, multiply by 10.

Abatacept and Sodium Thiosulfate for Treatment of Recalcitrant Juvenile Dermatomyositis Complicated by Ulceration and Calcinosis

“…Sodium thiosulfate is a potent antioxidant and vasodilator that also chelates and dissolves calcium deposits (8-11). In addition to decreasing the pain associated with ulcerative skin disease and calciphylaxis, it has been shown to decrease dystrophic calcification in calcific uremic arteriolopathy (calciphylaxis), iatrogenic calcinosis cutis, and tumoral calcinosis (8-10). Although it is primarily administered intravenously, topical use has been described for ulcerations associated with lupus calcinosis and uremic calciphylaxis (10).…”

“…In addition to decreasing the pain associated with ulcerative skin disease and calciphylaxis, it has been shown to decrease dystrophic calcification in calcific uremic arteriolopathy (calciphylaxis), iatrogenic calcinosis cutis, and tumoral calcinosis (8-10). Although it is primarily administered intravenously, topical use has been described for ulcerations associated with lupus calcinosis and uremic calciphylaxis (10). However, the use of this agent for treatment of dermatomyositis-associated calcinosis has not been previously reported.…”

Latent Dystrophic Subcutaneous Calcification in Patients with Chronic Venous Insufficiency

“…Surgical debridement of calcified masses would be the most eíTective treatment (4,6). A recent report demonstrated successful conservative treatment with topical sodium thiosulphate, which chelates calcium into calcium thiosulphate salts, which arc more soluble than calcium phosphate (8 of disodium etidronate may inhibit the progression of dystrophic calcification ( 12). Dystrophie calcification could be a risk factor for the failure of leg ulcer treatment in CVI patients.…”

“…Dystrophie calcification could be a risk factor for the failure of leg ulcer treatment in CVI patients. Calcium deposits impair normal epithelial growth and cause persistent inflammation with a foreign body reaction, resulting in delayed wound healing (6)(7)(8)(9). Formation of calcified and/or ossified nodules probably leads to a high recurrence rate of leg ulcers, which, in turn, increases the risk of further calcium salt deposition.…”

“…Ulcérations make the management of CVI difficult. Prior studies have suggested that calcified deposits in the skin impede wound healing and cause refractory ulcération ofthe lower legs (6)(7)(8)(9). However, unless calcified nodules extrude from ulcers, subcutaneous calcification may easily be overlooked.…”