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Clinical and ultrasound response to intralesional sodium thiosulfate for the treatment of calcinosis cutis in the setting of systemic sclerosis. A case-based review

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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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References

  1. Jiménez-Gallo D, Ossorio-García L, Linares-Barrios M (2015) Calcinosis cutis and calciphylaxis. Actas Dermosifiliogr 106(10):785–794

    Article  Google Scholar 

  2. Baumgartner-Nielsen J, Braae A (2016) Treatment of skin with intralesional injection of sodium thiosulfate: a case series. Acta Derm Venereol 96:257–258

    Article  CAS  Google Scholar 

  3. Strazzula L, Nigwekar SU, Tsiaras W et al (2013) Intralesional sodium thiosulfate for the treatment of calciphylaxis. JAMA Dermatol 149(8):946–949

    Article  Google Scholar 

  4. Reiter N, El-Shabrawi L, Leinweber B et al (2011) Calcinosis cutis: part II. Treatment options. J Am Acad Dermatol 65:15–22

    Article  Google Scholar 

  5. Dima A, Balanescu P, Baicus C (2014) Pharmacological treatment in calcinosis cutis associated with connective-tissue diseases. Rom J Intern Med 52:55–67

    PubMed  Google Scholar 

  6. Chander S, Gordon P (2012) Soft tissue and subcutaneous calcification in connective tissue diseases. Curr Opin Rheumatol 24:158–164

    Article  CAS  Google Scholar 

  7. Boulman N, Slobodin G, Rozenbaum M, Rosner I (2005) Calcinosis in rheumatic diseases. Semin Arthritis Rheum 34:805–812

    Article  Google Scholar 

  8. Guermazi A, Grigoryan M, Cordoliani F, Kérob D (2007) Unusually diffuse idiopathic calcinosis cutis. Clin Rheumatol 26:268–270

    Article  Google Scholar 

  9. Steen VD, Ziegler GL, Rodnan GP, Medsger TA (1984) Clinical and laboratory associations of anticentromere antibody in patients with progressive systemic sclerosis. Arthritis Rheum 27:125–131

    Article  CAS  Google Scholar 

  10. Vitiello M, Abuchar A, Santana N, Dehesa L, Kerdel FA (2012) An update on the treatment of the cutaneous manifestations of systemic sclerosis. The dermatologist’s point of view. J Clin Aesthet Dermatol 5(7):33–43

    PubMed  PubMed Central  Google Scholar 

  11. Chan AY, Li E (2005) Electric shock wave lithotripsy (ESWL) as a pain control measure in dermatomyositis with calcinosis cutis—old method, new discovery. Clin Rheumatol 24:172–173

    Article  Google Scholar 

  12. Chamberlain AJ, Walker NPJ (2003) Successful palliation and significant remission of cutaneous calcinosis in CREST syndrome with carbon dioxide laser. Dermatol Surg 29:968–970

    PubMed  Google Scholar 

  13. Bottomley WW, Goodfield M, Sheehan-Dare RA (1996) Digital calcification in systemic sclerosis: effective treatment with good tissue preservation using the carbon dioxide laser. Br J Dermatol 135:302–304

    Article  CAS  Google Scholar 

  14. Sparsa A, Lesaux N, Kessler E, Bonnetblanc JM, Blaise S, Lebrun-Ly V, Colombeau P, Vidal E, Bédane C (2005) Treatment of cutaneous calcinosis in CREST syndrome by extracorporeal shock wave lithotripsy. J Am Acad Dermatol 53:S263–S265

    Article  Google Scholar 

  15. Cicone JS, Petroonis JB, Embert CD et al (2004) Successful treatment of calciphylaxis with intravenous sodium thiosulfate. Am J Kidney Dis 43:1104–1108

    Article  Google Scholar 

  16. Cucchiari D, Torregrosa JV (2018) Calcifilaxis en pacientes con enfermedad renal crónica: una enfermedad todavía desconcertante y potencialmente mortal. Nefrologia 38(6):579–586

    Article  Google Scholar 

  17. Mageau A, Guigonis V, Ratzimbasafy V, Bardin T, Richette P, Urena P, Ea HK (2017) Intravenous sodium thiosulfate for treating tumoral calcinosis associated with systemic disorders: report of four cases. Joint Bone Spine 84:341–344

    Article  CAS  Google Scholar 

  18. Song P, Fett NM, Lin J, Merola JF, Costner M, Vleugels RA (2018) Lack of response to intravenous sodium thiosulfate in three cases of extensive connective tissue disease-associated calcinosis cutis. Br J Dermatol 178:1412–1415

    Article  CAS  Google Scholar 

  19. Wolf EK, Smidt AC, Laumann AE (2008) Topical sodium thiosulfate therapy for leg ulcers with dystrophic calcification. Arch Dermatol 144:1560–1562

    Article  Google Scholar 

  20. Barrio-Díaz P, Moll-Manzur C, Álvarez-Veliz S et al (2016) Topical sodium metabisulfite for the treatment of calcinosis cutis: a promising new therapy. Br J Dermatol 175(3):608–611

    Article  Google Scholar 

  21. Ratsimbbazafy V, Bahans C, Guigoins V (2012) Dramatic diminution of a large calcification treated with topical sodium thiosulfate. Arthritis Rheum 64:3826

    Article  Google Scholar 

  22. García-García E, López-López R, Álvarez-del-Vayo C, Bernabeu-Wittel J (2017) Iatrogenic calcinosis cutis successfully treated with topical sodium thiosulfate. Pediatr Dermatol 34(3):356–358

    Article  Google Scholar 

  23. Smith GP (2013) Intradermal sodium thiosulfate for exophytic calcinosis cutis of connective tissue disease. J Am Acad Dermatol 69(3):e146–e147

    Article  CAS  Google Scholar 

  24. Goosens J, Courbebaisse M, Caudron E et al (2017) Efficacy of intralesional sodium thiosulfate injections for disabling tumoral calcinosis: two cases. Semin Arthritis Rheum 47(3):451–455

    Article  Google Scholar 

  25. Ma JE, Ernste FC, Davis MDP, Wetter DA (2019) Topical sodium thiosulfate for calcinosis cutis associated with autoimmune connective tissue diseases: the Mayo Clinic experience. Clin Exp Dermatol 44(5):e189–e192

    Article  CAS  Google Scholar 

  26. Schulmeister L (2011) Extravasation Management: clinical update. Semin Oncol Nurs 27(1):82–90

    Article  Google Scholar 

  27. Ossorio-García L, Jiménez-Gallo D, Arjona-Aguilera C et al (2015) Calcifilaxis tratada con tiosulfato sódico intralesional. Actas Dermosifilogr 107(4):359–362

    Article  Google Scholar 

  28. Isoherranen K, Bouchard L, Kluger N (2017) Benefits of intralesional injections of sodium thiosulfate in the treatment of calciphylaxis. Int Wound J 14(6):955–959

    Article  Google Scholar 

  29. Gunasekera NS, Gracey-Maniar LE, Lezcano C et al (2017) Intralesional sodium thiosulfate treatment for calcinosis cutis in the setting of lupus panniculitis. JAMA Dermatol 153(9):944–945

    Article  Google Scholar 

  30. Touart DM, Sau P (1998) Cutaneous deposition diseases. Part II. J Am Acad Dermatol 39(4):527–544

    Article  CAS  Google Scholar 

  31. Wilmer WA, Magro CM (2002) Calciphylaxis: emerging concepts in prevention, diagnosis, and treatment. Semin Dial 15(3):172–186

    Article  Google Scholar 

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Correspondence to Ana Elísabet López-Sundh.

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López-Sundh, A.E., Quintana-Sancho, A., Durán-Vian, C. et al. 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 40, 2985–2989 (2021). https://doi.org/10.1007/s10067-020-05523-4

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