Background Calciphylaxis is a vasculopathy characterised by middle layer calcification in vessels and their inner layer proliferation, associated with fibrosis and luminal thrombosis resulting in necrosis of the surrounding tissues.

Purpose Description of different sodium thiosulfate formulations and analysis of the effectiveness and safety in a case of cutaneous necrosis by calciphylaxis.

Case Female, 44 years, recipient of a kidney transplant and receiving haemodialysis. The patient showed an ulcerated lesion in the right leg that she associated with an insect bite. Later, similar and very painful injuries appeared on the contralateral leg. Once diagnosed with cutaneous necrosis by calciphylaxis ulcers, treatment based on sodium thiosulfate was suggested: antioxidant agent, vasodilator and calcium chelator.

Results It was decided to administer the patient sodium thiosulfate by three different ways: intravenously¹ 25 g/1.73 m² of corporal surface, three times a week during haemodialysis treatment; intralesionally² 1/6 M concentration monthly dosage; and topical solution³ 10% applied to the ulcerous lesions with occlusive dressing. For the intralesional sodium thiosulfate treatment, 1/6 M vials were injected. For the topical formulation, sodium thiosulfate was weighted and dissolved in purified water. Then, it was incorporated into cold cream by constant agitation until a homogeneous paste was formed. Furthermore, for intravenous sodium thiosulfate treatment, we weighted sodium thiosulfate and added sterile water to dissolve it and then made it up to the final volume. Then, the solution was dispensed into bottles in the laminar air flow (LAF) cabin with a 0.22 µm filter. Monitoring of lesion changes was followed and the patient was given 4 cycles of intralesional sodium thiosulfate treatment, a 4 month period of intravenous treatment and a 2 month period of topical application. Clinical improvement in the lesions was observed and no signs of intolerance were found.

Conclusion Although the scientific literature has reported on only a few patients, the clinical improvement and good tolerance to the topical, intralesional and intravenous formulations support the effectiveness and safety of using sodium thiosulfate in cutaneous necrosis by calciphilaxis treatment.

References and/or Acknowledgements

1. Carlos G. Use of sodium thiosulfate in the treatment of calciphylaxis. Saudi J Kidney Dis Transpl 2009;20:1065-8

2. Strazzula L. Intralesional sodium thiosulfate for the treatment of calciphilaxis. JAMA Dermatol 2013;149:946-9

3. Ratsimbazafy V. Dramatic diminution of a large calcification treated with topical sodium thiosulfate. Arthritis Rheum 2012;64:3826

References and/or AcknowledgementsNo conflict of interest.