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Microstructural comparative analysis of calcification patterns in calciphylaxis versus arteriolosclerotic ulcer of Martorell

  • Investigative Report
  • Published:
European Journal of Dermatology

Abstract

Background

Calciphylaxis and the arteriolosclerotic ulcer of Martorell (ASUM) represent two entities of cutaneous calcific arteriolopathies. Their differential diagnosis can be challenging, given similarities in their clinical and histological presentation. Calcification patterns have been proposed as a possible discriminative histological criterion, however, a systematic microstructural comparative analysis is lacking.

Objectives

The study aimed at a systematic comparative microstructural analysis of the calcification patterns in calciphylaxis versus ASUM.

Materials & Methods

Skin biopsies of patients with leg ulcers due to calciphylaxis (20) and ASUM (69) diagnosed at three European wound care centres (Vienna, Bern, Zurich) were included. The extent of calcification, arteriolar calcification pattern and presence of extra-arteriolar calcification were assessed.

Results

All calciphylaxis and most ASUM patients (77%) presented with arteriolar calcification. Although the mean number of calcified vessels and the proportion of calcified area were significantly higher in calciphylaxis specimens (p = 0.003 and p = 0.0171), there was no significant difference in the pattern of arteriolar calcification (p = 0.177). Interestingly, extra-arteriolar calcification was detected in the majority of both calciphylaxis (93.3%) and ASUM samples (85.2%, p = 0.639). Notably, Alizarin Red S staining was superior to H&E for the detection of calcifications of both entities (p = 0.014 and p < 0.0001), and to von Kossa staining for ASUM samples (p = 0.0001). However, no differences could be observed between cases with uraemic and non-uraemic calciphylaxis or ulcerations located on the upper and lower leg.

Conclusion

Our results indicate that extra-arteriolar calcification is not only present in calciphylaxis, but can also be detected in ASUM suggesting a lack of specificity for this finding. However, more specific calcification stains, such as Alizarin Red S, should be used in suspected cases, as calcifications may be overlooked using conventional H&E staining.

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Authors and Affiliations

  1. Skin and Endothelium Research Division (SERD), Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Julia Deinsberger, Stefani Sirovina, Sophie Bromberger, Peter Petzelbauer & Benedikt Weber

  2. Disease Modeling and Organoid Technology (DMOT) Research Group, Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Julia Deinsberger, Stefani Sirovina & Benedikt Weber

  3. Department of Dermatology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Julia Deinsberger, Sophie Bromberger, Kornelia Böhler, Peter Petzelbauer & Benedikt Weber

  4. Division of Biomedical Science, University of Applied Sciences FH Campus Wien, Favoritenstraße 226, 1100, Vienna, Austria

    Stefani Sirovina

  5. Clinical Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria

    Andreas Vychytil

  6. Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland

    Barbara Meier-Schiesser & Jürg Hafner

  7. Department of Dermatology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse 34, 3010, Bern, Switzerland

    Helmut Beltraminelli

Authors
  1. Julia Deinsberger
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  2. Stefani Sirovina
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  4. Kornelia Böhler
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  5. Andreas Vychytil
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  7. Peter Petzelbauer
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  8. Helmut Beltraminelli
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  9. Jürg Hafner
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  10. Benedikt Weber
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Corresponding author

Correspondence to Benedikt Weber.

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Disclosure

Financial support: We would like to thank the following funding institutions for their support: Austrian Science Fund (FWF; P-30615), Medical Scientific Fund of the Mayor of the City of Vienna (MA-GMWF-501912-2019), Vienna Science and Technology Fund (WWTF; LS18-080), and institutional funding of the Medical University of Vienna, Austria. Conflicts of interest: none.

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Deinsberger, J., Sirovina, S., Bromberger, S. et al. Microstructural comparative analysis of calcification patterns in calciphylaxis versus arteriolosclerotic ulcer of Martorell. Eur J Dermatol 31, 705–711 (2021). https://doi.org/10.1684/ejd.2021.4182

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  • DOI: https://doi.org/10.1684/ejd.2021.4182

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