Calciphylaxis

Synonym(s)

Necrotizing livedo reticularis; uremic gangrene syndrome; uremic necrosis; calcific uremic arteriolopathy; obliterative calcific-thrombotic arteriolopathy

Definition

Syndrome of vascular calcification with cutaneous necrosis, usually in patients with renal failure

Pathogenesis

Pathogenic factors possibly include chronic renal failure, hypercalcemia, hyperphosphatemia, an elevated calcium-phosphate product, and secondary hyperparathy-roidism

Clinical manifestation

Presents as livedo reticularis or as ery-thematous papules or plaques, mostly on the lower extremities, evolving into stellate purpuric ulcerations with central necrosis; extreme pain and tenderness in lesions

Differential diagnosis

Polyarteritis nodosa; pyoderma gangreno-sum; Wegener's granulomatosis; lupus ery-thematosus; cryoglobulinemia; coumarin

Calcipotriene 113

necrosis; protein C or protein S deficiency; antiphospholipid syndrome; atherosclerotic peripheral vascular disease; pancreatic panniculitis; cholesterol emboli; disseminated intravascular coagulation

Therapy

Total or subtotal parathyroidectomy only with evidence of hyperparathyroidism; aggressive wound care and debridement of necrotic tissue; dietary alteration with phosphate binders and low calcium-bath dialysis to decrease serum calcium and phosphate concentrations

References

Oh DH, Eulau D, Tokugawa DA, McGuire JS, Kohler S (1999) Five cases of calciphylaxis and a review of the literature. Journal of the American Academy of Dermatology 40(6 Pt 1)1979-987

Drug class

Vitamin D3 derivative Mechanism of action

Acts through the vitamin D nuclear receptor to regulate growth, differentiation, and immune functions

Dosage form

0.005% cream, ointment, lotion

Dermatologic indications and dosage

See table

Common side effects

Cutaneous: pruritus; irritant contact dermatitis; erythema

Serious side effects

Hematologic: hypercalcemia

Drug interactions

None

Calcipotriene

Trade name(s)

Dovonex

Generic available

Contraindications/precautions

Hypersensitivity to drug class or component

References

Lebwohl M, Ali S (2001) Treatment of psoriasis. Part 1. Topical therapy and phototherapy. Journal of the American Academy of Dermatology 45(4)^487-98

Calcipotriene. Dermatologic indications and dosage

Disease

Adult dosage

Child dosage

Epidermolytic

Apply twice daily

Apply twice daily

hyperkeratosis

Grover's disease

Apply twice daily

Apply twice daily

Inflammatory linear

Apply twice daily

Apply twice daily

verrucous nevus

Morphea

Apply twice daily

Apply twice daily

Porokeratosis

Apply twice daily

Apply twice daily

Psoriasis

Apply twice daily

Apply twice daily

Reiter syndrome

Apply twice daily

Apply twice daily

Vitiligo

Apply twice daily

Apply twice daily

114 Callosity

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