The treatment of<unk>  requires a multidisciplinary approach, using the knowledge of nephrologists, plastic surgeons, dermatologists, and wound care specialists working together to manage the disease and its outcomes. The key to treating<unk>  is prevention via rigorous control of phosphate and calcium balance and management of risk factors in patients who have increased chances of developing<unk> . There is no specific treatment. Most treatment recommendations lack significant data, and none are internationally recognized as the standard of care. It is generally accepted to apply a multi-pronged approach to each patient. Analgesia and wound management Pain management and choice of analgesia is a challenging task in managing<unk> . Pain is one of the most severe and pervasive symptoms of the disease and can be unresponsive to high-dose opioids. Fentanyl and methadone are preferred analgesics over morphine, since morphine breakdown produces active metabolites that accumulate in the body of patients with kidney failure. Adjunct medications such as gabapentin and ketamine may also be used for analgesia. In refractory cases, spinal anesthetics (nerve blocks) can be used for more comprehensive pain relief. Wound care for<unk>  lesions involves using appropriate dressings, wound debridement (removal of dead tissue), and prevention of infection. Wound infections lead to sepsis, which is one of the leading causes of death in patients with<unk> . Surgical wound debridement carries increased risk for infection, so it should only be considered as therapy if the survival benefit outweighs the chances of continued wound non-healing and pain. Hyperbaric oxygen therapy may also be considered. There are some smaller retrospective studies that show the use of hyperbaric oxygen in improving delivery of oxygen to wounds, which improves blood flow and helps with wound healing. Risk factor mitigation Most patients with<unk>  are already on hemodialysis, or simply dialysis, but the length or frequency of sessions may be increased. The majority of dialysis patients are on a 4-hour three times per week schedule. Indications for increasing dialysis session length or frequency include electrolyte and mineral abnormalities, such as hyperphophatemia, hypercalcemia, and hyperparathyroidism, all of which are also risk factors for development of<unk> . Peritoneal dialysis patients should also transition to hemodialysis, as only hemodialysis carries the added benefit of better phosphate and calcium control. Surgical parathyroidectomy is also recommended for those who have difficulty managing phosphate and calcium level balance. However, risks include development of post-operative hungry bone syndrome (HBS), a disease state that causes low calcium and requires use of calcium supplementation and calcitriol, which should be avoided in patients with end-stage kidney disease and<unk> . Pharmacotherapy Sodium thiosulfate is commonly prescribed for treatment in patients with<unk> . The actual mechanism of the drug is unknown, but several theories have been proposed, including chelation of calcium, vasodilation, antioxidant properties, and restoration of endothelial function. Adverse effects of sodium thiosulfate include high anion gap metabolic acidosis and high sodium levels (hypernatremia). Bisphosphonates are a popular choice for the treatment of osteoporosis, but they have also been used to treat<unk>  even though the exact mechanism in<unk>  is unknown. They are most beneficial in patients who have a genetic ENPP1 deficiency and have been shown to slow development of<unk>  lesions in a small prospective study. Cinacalcet (medical parathyroidectomy) is an oral medication that can be used to suppress the parathyroid glands for patients who may not be able to undergo surgical parathyroidectomy. Vitamin K supplementation has also been shown to slow development of calcification in coronary arteries and the aortic valve in older patients. The ability for vitamin K supplementation to slow calcification of blood vessels in<unk>  is not well studied. Warfarin, a vitamin K antagonist discussed above, should be discontinued if possible. Other acceptable treatments may include one or more of the following: * Clot-dissolving agents (tissue plasminogen activator) * Maggot larval debridement * Correction of the underlying plasma calcium and phosphorus abnormalities (lowering the Ca x P product below 55 mg2/dL2) * Avoiding further local tissue trauma (including avoiding all subcutaneous injections, and all not-absolutely-necessary infusions and transfusions) * Patients who receive kidney transplants also receive immunosuppression. Considering lowering the dose of or discontinuing the use of immunosuppressive drugs in people who have received kidney transplants and continue to have persistent or progressive calciphylactic skin lesions can contribute to an acceptable treatment of<unk> . * A group has reported plasma exchange effective and propose a serum marker and perhaps mediator (calciprotein particles)
Calciphylaxis
Tachyphylaxis
Purpura fulminans
Acne fulminans
Tetanus
Phlebothrombosis
Papular purpuric gloves and socks syndrome
Visceral larva migrans