Late-onset dystrophic calcinosis cutis in a burn scar treated with topical sodium thiosulfate: a case report and review of the literature.
James Bozzi1, 1St George Hospital, Kogarah, NSW, Australia
Abstract
Calcinosis cutis(CC) is an uncommon, chronic calcium-deposition disorder of the subcutaneous tissues, often resulting in chronic wounds. Dystrophic CC, the most common subtype, often occurs in patients with an underlying autoimmune connective-tissue disease, however, 12 prior cases of this phenomenon occurring in old burn scars exist in the literature. Surgical excision and laser have variable results, with frequent recurrence or failure. While compelling evidence for topical sodium thiosulfate(TST) as a chelating agent to increase calcium resorption exists in non-burn wounds, no reports for its use in burns exist.
A 50-year-old male with scleroderma presented with an infected left pretibial wound after breakdown of a minor old burn scar. He underwent debridement in theatres, with resultant histological CC diagnosis. Refractory to silver based and VAC dressings, it progressed to a 5x8cm full thickness defect. A literature review was completed to ascertain the efficacy of TST in wounds. TST was trialled with complete local response (soft-tissue resorption of calcium confirmed on bone scan) and he was then amenable to grafting.
16 publications, reporting 48 patients with CC treated with TST were identified. Mean age was 51 years, 76% were women, the majority involved the limbs and mean duration of treatment was 4 months. 19% had complete, 60% partial and 21% had no response. One patient was allergic. Our patient was the only reported case of CC with a wound greater than 3cms.
Topical sodium thiosulfate may represent a safe and effective adjuvant in the management of calcinosis cutis in chronic burn scars.
References
1.Lee HW, Jeong YI, Suh HS, et al. Two cases of dystrophic calcinosis cutis in burn scars. JDermatol. 2005;32(4):282-285. doi:10.1111/j.1346-8138.2005.tb00763.x
2.Róbert L, Kuroli E, Bottlik G, Hidvégi B. Late-onset calcinosis in burn scars: A review of the literature and two case reports. JDtschDermatolGes. 2022;20(2):141-148. doi:10.1111/ddg.14677
Biography
Dr James Bozzi is an unaccredited plastic surgery registrar based in NSW with an interest in burns.