Calciphylaxis

Calciphylaxis (Calcific Uremic Arteriolopathy)

Overview

Calciphylaxis is a rare, life-threatening condition characterized by calcification of small blood vessels in the skin and subcutaneous fat, leading to thrombosis, ischemia, and painful necrotic skin ulcers. It most commonly occurs in patients with end-stage renal disease on dialysis, but can also occur in patients with normal renal function. The mortality rate is very high, making early recognition and aggressive management critical.

Key Symptoms

• Extremely painful, firm, violaceous (purple) patches or plaques
• Reticular (net-like) purpura or livedo reticularis pattern
• Progressive necrosis with black eschar formation
• Subcutaneous nodules that may be palpable before skin changes appear
• Most commonly on the thighs, abdomen, and buttocks (areas with the most subcutaneous fat)
• Wounds become infected easily, contributing to sepsis and mortality

Affected Areas

Thighs, Abdomen, Buttocks, Lower legs, Areas with significant subcutaneous fat

Care Instructions

1. Seek urgent evaluation — calciphylaxis is a medical emergency with high mortality.
2. Multidisciplinary care involving dermatology, nephrology, and wound care is essential.
3. Sodium thiosulfate infusions are a key treatment.
4. Aggressive wound care and pain management are critical.
5. Optimize dialysis, correct calcium-phosphorus imbalance, and discontinue calcium-based phosphate binders.
6. Avoid skin trauma, subcutaneous injections, and warfarin if possible.

Medical Disclaimer: This information is for educational purposes only and does not replace professional medical advice. Always consult a qualified dermatologist for diagnosis and treatment.

Prevalence: Rare; estimated incidence of 1-4% of dialysis patients per year; extremely rare in non-uremic patients