Clinical and ultrasound response to intralesional sodium thiosulfate for the treatment of calcinosis cutis in the settin
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CASE BASED REVIEW
Clinical and ultrasound response to intralesional sodium thiosulfate for the treatment of calcinosis cutis in the setting of systemic sclerosis. A case-based review Ana Elísabet López-Sundh 1 & A. Quintana-Sancho 1 & C. Durán-Vian 1 & L. Reguero-DelCura 1 & A. F. Corrales-Martínez 2 & C. Gómez-Fernández 1 & M. A. González-López 1 Received: 12 September 2020 / Revised: 22 November 2020 / Accepted: 23 November 2020 # International League of Associations for Rheumatology (ILAR) 2020
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. Keywords Calcinosis cutis . Sodium thiosulfate . Systemic sclerosis . Ultrasound
Introduction Calcinosis cutis (CC) is defined as the deposition of calcium salts on the skin and subcutaneous tissue, and it is associated with different conditions, including some autoimmune diseases [1]. Clinically, it adopts a wide range of manifestations: from localized plaques or nodules to large areas of calcium deposits that may extrude through the skin or form true exoskeletons. CC deposits can generate significant inflammation, pain, tissue retraction, fistulation, and functional impairment. Eventually, they can ulcerate and become infected, complicating the prognosis [2, 3]. Numerous therapies have been tried with highly variable results [1, 4, 5], but there is still no standard treatment. Given
* Ana Elísabet López-Sundh [email protected] 1
Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
2
Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
its low cost, safety profile, and the favorable clinical outcome reported in the literature [2, 3], intralesional injection of sodium thiosulfate (STS) appears as a legitimate and promising therapeutic option for the treatment of CC.
Case description A 27-year-old woman diagnosed with diffuse systemic sclerosis (SSc) was referred to our Dermatology department in August 2018 with two painful plaques on both axillae of 8 weeks of evolution, which caused skin tightness and l
