AB0595 EFFECTIVENESS OF TOPICAL SODIUM TIOSULFATE FOR THE TREATMENT OF CALCINOSIS-ASSOCIATED CUTANEOUS ULCERS IN PATIENTS WITH SYSTEMIC SCLEROSIS
Authors: I. Torner Hernández, A. Sendra-García, V. Núñez-Monje, L. Montolio-Chiva, A. V. Orenes Vera, I. Vázquez-Gómez, E. Flores Fernandez, À. Martínez-Ferrer, E. Valls-Pascual, D. Ybáñez-García, J. J. Alegre-Sancho
Journal: Annals of the Rheumatic Diseases (2020)

Background: Treatment of calcinosis associated with systemic sclerosis (SSc) mainly involves the use of systemic therapies, which often have limited efficacy. However, little attention has been paid to local treatment, which is especially useful when associated with skin ulcers. Objectives: To show our experience with topical sodium thiosulfate (TST) for the treatment of calcinosis-associated cutaneous ulcers in patients with SSc. Methods: Descriptive analysis of a case series of patients with SSc and calcinosis-associated skin ulcers treated with TST. Wound management procedure : wounds and perilesional skin cleaning and disinfection is performed and, if needed, additional debridement. TST is compounded at 25% as w/o emulsion, for extensive calcinosis, or as beeler-base or cold-cream ointment, for limited calcinosis. Wounds are then covered with a polymeric foam dressing. This cure in moist healing environment shows some advantages over the dry cure (exudate control without damaging the periulceral skin, protection against contamination, and reduction of the needed cures, healing time and pain). Results: Nine patients (7 women) with calcinosis-associated skin ulcers and SSc were included: 2 patients with diffuse SSc (DcSSc), 6 with limited SSc (LcSSc) and 1 with overlap syndrome. Median age was 60 years (IQR 20). 6 patients had localized wounds and 3 had extensive involvement and/or tumoral calcinosis which had been refractory to systemic treatment with diltiazem, colchicine, zoledronate, rituximab, and/or acenocoumarol and had suffered recurrent superinfections. Follow-up results of more than 3 months are available for 8 patients, who have been on TST a median time of 9 months (IQR 8.25). They have shown clinical improvement (disappearing of many calcinosis foci and partial or complete healing of the ulcers together with an improvement in pain, function, quality of life and satisfaction of the patients). Radiological improvement was also observed in 1 case. No TST related adverse effect has been detected, except for slight maceration of the wound edges due to the ointment preparation, which was resolved by protecting these with zinc oxide cream Conclusion: In our experience, treatment with TST for calcinosis-associated skin ulcers in patients with SSc is an effective, safe and easily implementable therapeutic alternative in clinical practice. Disclosure of Interests: Inmaculada Torner Hernández: None declared, A Sendra-García: None declared, V Núñez-Monje: None declared, L Montolio-Chiva: None declared, Ana V Orenes Vera: None declared, I Vázquez-Gómez: None declared, Eduardo Flores Fernandez: None declared, À Martínez-Ferrer: None declared, Elia Valls-Pascual Grant/research support from: Roche, Novartis, and AbbVie, Speakers bureau: AbbVie, Lilly, Pfizer, MSD, Novartis, Janssen, Bristol Myers Squibb, UCB Pharma, D Ybáñez-García Speakers bureau: Lilly, Roche, Sanofi, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis