Calciphylaxis is a rare disease histopathologically characterized by calcification of the medial layer of small cutaneous vessels, resulting in painful and intractable skin ulcerations in the legs. The disease is potentially lifethreatening, with more than 50% of patients dying within 1 year of diagnosis 1). Secondary infections and organ failure are also possible complications. Patients with end-stage renal disease are most susceptible to calciphylaxis; however, calciphylaxis may also affect patients with hypoparathyroidism requiring calcium salts or vitamin D, those with obesity, and those using warfarin. Ever since Cicone et al. 2) reported the successful treatment of calciphylaxis with intravenous sodium thiosulfate (STS), STS therapy has been commonly used as the first-line treatment for this disease, showing beneficial effects in most patients 3). However, systemic STS may have various side effects, such as nausea, vomiting, hypocalcemia, metabolic acidosis, and QTinterval prolongation. According to several recent reports, intralesional STS may prevent systemic side effects, but it may cause pain during injection. Although the use of STS has been described in case reports, case series, and in a single retrospective review, the effects and side effects of STS on calciphylaxis have not been confirmed by blinded randomized clinical studies. Therefore, a standardized treatment protocol for STS has not been

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Asai Non-member (MACOHO Co., Ltd.) Toru Matsubara Non-member (MACOHO Co., Ltd.