32522 Refractory calcinosis cutis in limited systemic sclerosis treated with CO2 ablation and curettage

Abstract

We present a case of a 50-year-old woman with limited systemic sclerosis with debilitating digital calcinosis cutis. Our patient reported tenderness with moderate limitation of her daily activities secondary to her fingertip nodules. She had previously undergone multiple debridements with orthopedic surgery under general sedation or with a nerve block. Due to the postoperative pain and logistical difficulty involved with the orthopedic surgeries, she opted to forgo further orthopedic surgery and presented to our dermatology department for evaluation. With dermatology, she trialed topical sodium thiosulfate twice a day for 6 months with no improvement, followed by intralesional sodium thiosulfate every 2 weeks for 4 months without notable benefit. Ultrasounds were performed to objectively assess response to treatment. Due to insufficient response, the patient successfully underwent 3 separate trials of continuous wave carbon dioxide (CO2) laser ablation followed by curettage for a 3 symptomatic nodules. There were no recurrences of the treated nodules at 6 months. She has experienced significant improvement in discomfort and functionality. Ablative CO2 laser therapy has rarely been used for treating digital calcinosis cutis, largely due to the appropriate concern for poor wound healing. However, in a review of the literature performed by Melone et al of 70 scleroderma patients requiring 272 hand operations did not reveal any complications with wound healing. We present this case to highlight ablative CO2 as a potential therapeutic option for patients with calcinosis cutis refractory to noninvasive methods.