COPENHAGEN – Intralesional sodium thiosulfate injections are an effective treatment for the painful and disabling dystrophic calcifications associated with systemic sclerosis, lupus, and other autoimmune diseases, as well as with nephrogenic systemic fibrosis, Dr. Jane Baumgartner-Nielsen said at the annual congress of the European Academy of Dermatology and Venereology.
“We suggest that intralesional injections of sodium thiosulfate may be considered in severe or ulcerated lesions before surgery or amputation,” said Dr. Baumgartner-Nielsen of Aarhus (Denmark) University.
Treatment of these often ulcerated cutaneous lesions has traditionally been challenging. While surgery is common, it’s problematic because wound healing is often prolonged in patients with autoimmune disease, she observed.
She presented a case series of six patients who underwent interlesional injections of sodium thiosulfate for painful and disabling dystrophic calcifications. The lesions were located on extensor surfaces or the fingertips. They were extremely painful: patients rated their pain as 9 on a 10-point scale. All six patients were women. Five had anticentromere antibody–positive systemic sclerosis; other investigators have reported that dystrophic calcifications occur in roughly 70% of such patients. The sixth patient had nephrogenic systemic fibrosis.
The six patients underwent a total of 21 injections of eight lesions. The injections were placed at the base of the calcifications. The concentration of sodium thiosulfate employed was 150 mg/mL. Dystrophic calcifications less than 5 mm in diameter on the fingertips received a single injection. Larger lesions complicated by ulceration got four injections at 4-week intervals.
The lesions decreased in size by an average of 67% at 4 weeks and 90% at 12 weeks. Complete remission was achieved by week 12 in half of patients; the other half had 80% reduction of their lesions. All patients reported dramatically less pain and improved physical function, compared with baseline. There were no serious side effects.
Audience member Dr. Alice B. Gottlieb inquired as to how painful the injections are.
“About 9 or 10 on a 10-point scale, but the pain disappears very quickly. In 30 seconds the patient is smiling again,” Dr. Baumgartner-Nielsen replied.
Dr. Gottlieb said she was interested in the intralesional therapy for her pediatric lupus patients with dystrophic calcifications. “But if there’s that much injection site pain, you might have to put the kid out,” noted Dr. Gottlieb, professor and dermatologist-in-chief at Tufts Medical Center, Boston.
Dr. Baumgartner-Nielsen reported having no financial conflicts regarding her study.