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The truth behind the fatal wound: Why does calcific dermatosis occur so frequently in dialysis patients?
Calcific dermatosis, or Calcific Uremic Arteriolopathy (CUA), is a rare but fatal syndrome that often occurs in patients with end-stage renal disease. The cause of the disease is unknown, but it is associated with calcification of small blood vessels, the formation of blood clots, and the subsequent death of skin cells. Due to the severe pain and ulcers it causes, patients' quality of life is greatly reduced, and the prognosis is extremely poor. Many patients survive less than one year after diagnosis.
The incidence of calcific dermatosis is 1-4% in dialysis patients, and the long-term consequences of its consequences are troubling.
Symptoms and pathological features
The first symptoms of calcific dermatosis are usually discoloration and hardness of the skin, followed by the characteristic pattern of bruising or varicose veins. When thrombosis occurs in the tissue, the ulcer will develop into a black crust that causes pain, rarely heals, and is prone to infection. This skin lesion usually presents in a bilateral posture, most commonly on the lower limbs, abdomen, and buttocks.
These ulcers are always accompanied by great pain, leaving patients facing long-term suffering and possible systemic infection.
Causes and risk factors
At present, there is no clear conclusion on the specific cause of calcific dermatosis. Studies believe that in patients with end-stage renal disease, abnormal balance of calcium and phosphorus and intravascular calcium deposition are the main factors. These changes can lead to thrombus formation in small blood vessels, resulting in tissue ischemia and necrosis. In addition to kidney disease, certain drugs such as warfarin may also induce this disease.
Known risk factors include female gender, obesity, products high in calcium and phosphorus, and use of certain medications.
Diagnostic methods
The primary basis for diagnosing calcific dermatoses is clinical assessment. Characteristic skin lesions are usually purple-blue or black ulcers, and arterial calcification and blood flow obstruction can be confirmed by skin biopsy. Excisional biopsy is generally not recommended to avoid aggravating wound ulceration and necrosis.
Treatment options
Treatment of calcific dermatoses requires a multidisciplinary approach, including nephrologists, plastic surgeons, dermatologists and wound care specialists. Treatment focuses on pain management and wound care. However, pain management is particularly challenging in treatment, often requiring the use of medications such as fentanyl and methadone to control symptoms.
Effective wound care measures are required during treatment to avoid the occurrence of infection, because secondary infection is considered one of the potential causes of death.
Prognosis and future research directions
Overall, the clinical prognosis of calcific dermatoses is poor, and the 1-year mortality rate in patients with end-stage renal disease can be as high as 80%. Therefore, strengthening the understanding and early diagnosis of this disease is crucial to improving the prognosis of patients.
As medicine advances, researchers are looking for new treatments, including the use of drugs such as sodium thiosulfate, bisphosphonates, and vitamin K. However, the effectiveness of various treatments still needs more clinical research to confirm, and effective prevention strategies are worthy of further exploration.
Facing calcific skin disease, the medical team needs to integrate resources and provide comprehensive care. How can we further reduce the incidence of this fatal disease in dialysis patients?
