Intralesional Sodium Thiosulfate Treatment for Calcinosis Cutis in the Setting of Lupus Panniculitis

Gunasekera, Nicole; Maniar, Lia E. Gracey; Lezcano, Cecilia; Laga, Alvaro C.; Merola, Joseph F.

doi:10.1001/jamadermatol.2017.0966

Cited by 20 publications

(16 citation statements)

References 6 publications

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“…Included articles consisted of one prospective double-blind placebo-controlled pilot study [22], 7 case series [4,5,10,13,17,18,21,[31][32][33][34][35], and 27 case reports [36][37][38][39][40][41][42][43][44]. Five conference abstracts were included [19,21,33,45,46].…”

Section: Quality Assessmentmentioning

confidence: 99%

Local, non-systemic, and minimally invasive therapies for calcinosis cutis: a systematic review

2021

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Calcinosis cutis is a deposition of calcium in the skin and subcutaneous tissue, often accompanied by pain, reduced mobility, and chronic infections. Limited evidence is available about the feasibility and efficacy of therapies alternative to systemic treatment and surgical excision, both of which often lead to unsatisfactory results or complications. We conducted a systematic review to evaluate the efficacy and safety of topical and intralesional sodium thiosulfate, extracorporeal shock-wave lithotripsy (ESWL), and laser for calcinosis cutis. PubMed, Embase, and Web of Science were searched. Reports of calciphylaxis and treatment combined with systemic medications were excluded. A total of 40 studies including 136 patients were analysed. Partial or complete remission after monotherapy was observed in 64% to 81% of cases. Self-applied topical sodium thiosulfate required patient’s adherence (mean treatment duration, 4.9 months; range 2–24). Laser therapy enabled complete remission of microcalcifications after a single procedure (57%; 12/21). ESWL and intralesional sodium thiosulfate injections decreased calcinosis-associated pain (median reduction in VAS score, 3; range 0–9 and 1; range 0–5, respectively). The most common adverse event was scarring and hyperkeratosis, observed after CO2 laser (56%; 10/18). Intralesional sodium thiosulfate injections caused transient pain in over 11% of patients. Recurrences within the follow-up were rare (2%; 3/136). This study provides an overview of minimally invasive and local therapies that in selected cases might transcend conventional treatment. The limitation of this study is the poor level of evidence, which emerges mainly from non-randomized studies at high risk of bias.

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Section: Quality Assessmentmentioning

confidence: 99%

Local, non-systemic, and minimally invasive therapies for calcinosis cutis: a systematic review

2021

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“…Intralesional injection of sodium thiosulfate is a promising treatment with a low adverse-effect profile. 15 , 16 , 17 , 21 The mechanism of action of sodium thiosulfate in calcinosis cutis is hypothesized to result from the solution's high solubility of calcium thiosulfate salts that inhibit precipitation of calcium salt and promote dissolution of calcium deposits. 9 In comparison with the success of previous reports, our pilot study of 4 subjects treated with intralesional sodium thiosulfate showed improvement in 1 subject, as evidenced by decreased PGA scores and percentage change in lesion size, with no statistical significance between sodium thiosulfate– and placebo-treated lesions at baseline or by completion of the study.…”

Section: Discussionmentioning

confidence: 99%

“… 9 It has since been used successfully in several cases via intravenous, topical, and intralesional routes, with increased resolution of lesions and decreased associated pain. 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 However, treatment may be complicated by route-dependent limitations and adverse effects. Intravenous administration of sodium thiosulfate may subject patients to potential adverse effects, including fatigue, hypotension, gastrointestinal upset, and anion gap metabolic acidosis.…”

Section: Introductionmentioning

confidence: 99%

“…Although several reports have shown positive responses to intralesional sodium thiosulfate for calcinosis cutis, only 1 study was prospective and obtained partial response. 15 , 16 , 17 , 21 To address the gap in controlled trials, our study sought to create a prospective, double-blinded investigation of the efficacy of intralesional sodium thiosulfate versus normal saline in dystrophic calcinosis cutis.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of intralesional sodium thiosulfate for the treatment of dystrophic calcinosis cutis: A double-blind, placebo-controlled pilot study

et al. 2020

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Background: Intralesional injection of sodium thiosulfate has emerged as a promising therapy for calcinosis cutis, but to our knowledge there are no randomized controlled trials evaluating its efficacy as a treatment. Objective: Conduct a prospective, double-blinded investigation of intralesional sodium thiosulfate versus normal saline in the treatment of dystrophic calcinosis cutis. Methods: This prospective pilot study injected normal saline or sodium thiosulfate at 0.1 mL/cm 2 into lesions at baseline and at 1-and 2-month follow-up. Subjects were followed for a total of 12 weeks. An inperson Physician Global Assessment score was assigned by the injecting physician at each visit and was repeated by an independent observer. Results: Of 4 subjects who completed the study, only 1 experienced improvement in the size and Physician Global Assessment score of the lesion. By 3-month follow-up, there was no difference between the average size of the treatment and control lesions (P = .39). Limitations: This was a small single-center study with limited demographic diversity and a short follow-up period. Only dystrophic calcinosis cutis subjects were included, and subjects received only 3 monthly injections of sodium thiosulfate. Conclusions: With only 1 positive response, our results highlight the need for further study of sodium thiosulfate treatment for dystrophic calcinosis.

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“…Intralesional sodium thiosulfate has been successfully used in the treatment of CC associated with ACTD . The efficacy of this inorganic salt for calcium‐mediated disorders may be multifactorial, possibly including its anti‐inflammatory and antioxidant properties, and its ability to chelate calcium into calcium thiosulfate salts, thereby increasing the solubility of calcium .…”

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confidence: 99%

Topical sodium thiosulfate for calcinosis cutis associated with autoimmune connective tissue diseases: the Mayo Clinic experience, 2012–2017

Ernste

Davis

et al. 2018

Clin Exp Dermatol

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Summary In this case series, we retrospectively identified all patients treated with topical sodium thiosulfate (TST) for calcinosis cutis (CC) associated with underlying autoimmune connective tissue diseases at Mayo Clinic (Rochester, MN, USA) during the period 1 January 2012 to 27 June 2017. Of 28 patients identified (mean age 57.0 years; 96% female), 19 (68%) had clinical improvement of their CC with TST, 7 (25%) had no response and 2 (7%) had unknown response. There were adverse events in three patients: two had skin irritation and the third, who had a zinc allergy, experienced pain with application. Overall, our findings support those of previous case reports that TST appears to be a relatively well‐tolerated adjuvant treatment for CC, although future studies with a control group are warranted to assess the true efficacy of TST for the indication of CC.

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Intralesional Sodium Thiosulfate Treatment for Calcinosis Cutis in the Setting of Lupus Panniculitis

Cited by 20 publications

References 6 publications

Local, non-systemic, and minimally invasive therapies for calcinosis cutis: a systematic review

Local, non-systemic, and minimally invasive therapies for calcinosis cutis: a systematic review

Efficacy of intralesional sodium thiosulfate for the treatment of dystrophic calcinosis cutis: A double-blind, placebo-controlled pilot study

Topical sodium thiosulfate for calcinosis cutis associated with autoimmune connective tissue diseases: the Mayo Clinic experience, 2012–2017

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