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Wound Healing, Ulcers, and Scars
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Saloni Shah, Christian Albornoz, Sherry Yang
Clinical presentation: Patients present with painful necrotic ulcerations that can extend into the epidermal, dermal, and subcutaneous adipose tissue layers (Figure 17.6). The pathophysiology is not well understood; however, previous epidemiologic studies have found that calciphylaxis is more prevalent in those who are on dialysis for end-stage renal disease. The incidence of uremic calciphylaxis is relatively low, but it is often rapidly progressive and carries high morbidity and mortality rates.
Endocrine emergencies with skin manifestations
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Skin manifestations are rarely seen in hyperparathyroidism. Calcinosis cutis due to elevated calcium and phosphate levels may be present. Calciphylaxis is a rare but life-threatening condition that is commonly associated with secondary hyperparathyroidism in the setting of chronic renal failure [16]. It is characterized by vascular calcification and thrombosis. It clinically presents with severe painful skin lesions (livedo reticularis, reticulate purpura, violaceous plaques, or indurated nodules) that evolve into nonhealing ulcers covered with black eschar and finally lead to tissue gangrene. Both the trunk and extremities can be involved [17].
Development of palliative medicine in the United Kingdom and Ireland
Published in Eduardo Bruera, Irene Higginson, Charles F von Gunten, Tatsuya Morita, Textbook of Palliative Medicine and Supportive Care, 2015
Calciphylaxis is a rare and serious disorder characterized by systemic medial calcification of the arterioles that leads to ischemia and subcutaneous necrosis. Â 85 Calciphylaxis most commonly occurs in patients with end-stage renal disease (ESRD) who are on hemodialysis or who have recently received a renal transplant. Calciphylaxis should be suspected in patients with skin lesions characterized by painful, nonulcerating subcutaneous nodules or plaques, nonhealing ulcers, and/or necrosis, which are most commonly present in the thigh and areas of increased adiposity. Â 86,87 Ulceration carries a mortality of greater than 80%. There should be an aggressive program of wound care and adequate pain control, avoidance of local tissue trauma.
Surgical treatment of nonuremic calciphylaxis: a case report and review of literature
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Minami Tamagake, Munetomo Nagao, Chieko Miura, Yoshimichi Imai
Calciphylaxis is a rare and extremely painful disease characterized by painful skin ulcerations and necrosis in various areas of the body and has a high mortality rate, with 1-year mortality rate reported as 45–80% [1]. Calciphylaxis is typically diagnosed in patients with end-stage kidney disease, affecting up to 4% of long-term dialysis patients, also known as calcific uremic arteriolopathy (CUA) [1]. Exceptionally, some nonuremic cases of calciphylaxis have also been reported. Although wounds of calciphylaxis are often difficult to heal, effective treatment has not yet been established. Calcification of the medial arterioles in subcutaneous and adipose tissues leads to vascular thromboses, resulting in ischemic necrosis or ulcerations [2]. Despite the high mortality rate, mainly due to sepsis attributed to wound infections [3], aggressive surgical treatment, such as extensive debridement or reconstructive surgery, is uncommon because ischemic tissue is thought to delay healing. On the other hand, leaving infected calciphylaxis lesions can lead to sepsis; therefore, infected or necrotic tissue may require emergent surgical debridement. We report the treatment over 2 years of a patient with nonuremic calciphylaxis caused by trauma, who was successfully treated with aggressive debridement and reconstruction using split-thickness skin grafting.
Use of the optimized sodium thiosulfate regimen for the treatment of calciphylaxis in Chinese patients
Published in Renal Failure, 2022
Xin Yang, Yuqiu Liu, Xiaotong Xie, Wen Shi, Jiyi Si, Xiaomin Li, Xiaoliang Zhang, Bicheng Liu
In summary, this study confirmed the effectiveness of an optimized STS regimen as a promising approach for the treatment of patients in China with calciphylaxis. The treatment was relatively safe, associated with satisfactory outcomes, and well tolerated by patients for short to medium treatment duration. To our knowledge, this was the first systematic study on the curative effect of STS for calciphylaxis in the Chinese population. Our center offers referential data to help Chinese doctors assess and modify their line of treatment based on our own ethnic, demographic, and clinical data, rather than relying solely on available literature. In addition, compared with many cases or case series reports, our research provided a more objective assessment of the outcomes and prognosis of patients with calciphylaxis during the courses of treatment.
Calciphylaxis in patient with peritoneal dialysis: A case report
Published in Cogent Medicine, 2020
Yunlei Deng, Ying Shu, Rong Gong
Calciphylaxis is a rare, life-threatening syndrome of vascular calcification characterized by occlusion of microvessels in the subcutaneous adipose tissue and dermis that results in intensely painful, ischemic skin lesions (Nigwekar, Thadhani, Brandenburg, & Ingelfinger, 2018; Nigwekar et al., 2016). Calciphylaxis can be classified into uremic or nonuremic, according to the involvement of end-stage renal disease (ESRD). However, calciphylaxis is most commonly seen in ESRD or hyperparathyroidism, and 70–80% of uremic calciphylaxis with a central distribution (Nigwekar et al., 2018; Weenig, Sewell, Davis, McCarthy, & Pittelkow, 2007). The peripheral lesion tends to have a lower body mass index, are more likely to be male and have a lower mortality (Nigwekar et al., 2016; Zitt et al., 2013).