A case of acquired perforating dermatosis successfully treated with sodium thiosulfate, used for accompanying calciphylaxis

Abstract

A 56-year-old male was referred to our dermatology department with foot ulcers. Due to diabetic nephropathy, he had received hemodialysis for 10 years. From the rst quarter of 2015, he noticed ulcerative digits of the foot. As the foot X-ray indicated calciphylaxis, we controlled his calcium and phosphate serum levels, and performed topical debridement of the ulcers. Although his ulcers were improved for a while, the ulcers on the 3rd and 4th toes of the right foot was worsened from the beginning of 2016. On admission, we observed itchy, keratotic nodules and papules on the shins. Histologically, Kossa stain-positive deposits of calcium were revealed around the vessels from the ulcer on the 3rd toe. Furthermore, transepithelial elimination of denatured elastic bers was observed from the keratotic papule specimen on the shins, which led to the diagnosis of acquired perforating dermatosis. After we treated him with sodium thiosulfate for calciphylaxis, the keratotic plaques were also attened and improved. Thiosulfate may improve acquired perforating dermatosis by solubilizing insoluble cutaneous deposits and ameliorating inammation.