- Think about calciphylaxis in your ESRD patients with non-healing ulcers in areas of adiposity (abdomen, buttocks, thighs, legs)
- Biopsy shows arterial calcifications without vasculitis
- Often associated with elevated PTH levels and elevated calcium-phosphorous product, hypoalbuminemia
- Check out this UCSF resident hand-out on calciphylaxis!
- We had a great review of features of chronic venous stasis including lipodermatosclerosis (inverted champagne bottle), atrophie blanche, telangiectasias, ulcerations on the medial ankles.
- See the table below for comparison/contrast of arterial versus venous ulcers
|Pathophysiology||Reflux and Venous stasis, faulty valves||Atherosclerosis, embolic|
|Skin Findings||Lipodermatosclerosis (inverted champagne bottle)
Pale, Shiny, Taut
|Ulcers||Shallow, superficial, irregular borders||Punched out, deep, full thickness wounds|
|Pain||Less painful usually, improves with leg elevation||Severe pain, improves with lowering legs|
|Ulcer Location||Medial and lateral malleolar||Above bony prominences, pressure points, base of heel|