Editor's Note: In this interview from SAWC Fall 2023, Dr. Basil Khalaf explains what calciphylaxis is and briefly discusses the research he presented on the condition.

Transcript

My name is Basil Khalaf, MD. I am a physician based out of Houston, Texas. I did my training in general surgery and emergency medicine in a fellowship in hyperbaric and wound medicine. I created a company called MEDiKAL that deals with wounds of all natures and we focus mainly on more complex wounds.

What is calciphylaxis and how does it contribute to the formation of wounds?

Calciphylaxis is a rare condition, however, I don't believe it's really rare. I think it's a little underdiagnosed. It is a condition which is most prevalent in patient populations who are in end-stage renal disease. However, we do see it in other conditions. It develops from creating basically calcific deposits within the small vessels, the microvascular anatomy of the body in which you create a hypoxic ischemic milieu around the skin and so you start getting necrosis of the skin.

The hallmark feature of it is pain, pain, pain, because like any other ischemic disease, pain is very common with them. You see it a lot with vascular surgeries when you have clogged arteries and the patients come in with a cold leg and having a lot of pain. And so it's kind of this same phenomena only into the skin and dealing with more small microvascular vessels.

History is paramount in this. You have to keep your Spidey-senses aware of what's going on. It's seen in patients with more comorbidities, especially if they're end-stage renal disease patients. But the hallmark feature is when you're asking them about the pain, it is extremely tender.

And the other thing is, if you look at it, it doesn't look like it's because of an infection. This is not, I mean, you can have a comorbidity where it gets infected afterwards, but it's not an infection kind of phenomena. This is a lack of blood flow kind of phenomena. So, not a lot of pus comes out of it. It's not really cellulitic. So, there's not that purulent discharge coming out. It is an extremely tender eschar that turns really, really leathery and dark and black and they are normally screaming of pain.

What are some treatment options available for this condition, and what did you find in your recent case series?

Unfortunately, most of those cases deal with patients with end stage renal disease who are very, very advanced in the disease process. And, if you look at a lot of the research, its directed towards more of the systemic disease process, in which you see the outcomes of survival are unfortunately not very favorable.

You're talking about 50 % of patients do not survive 1 or 2 years at most. So, and there are treatment treatments right now that are present, one of which is sodium thiosulfate and that's given systemically with treatments of the dialysis patients. However, it's been done intradermally and there's also the use of steroids which is ironic because steroids is also a contributor to the disease along with other medications such as warfarin. So, there's not really great treatments at this time and people are focused more on the systemic problem and not on the wounds itself.

So, in my research we kind of took a step back and said “I understand that the outcomes of these patients are not favorable, however they should not be suffering in the last days or months or years that they have." So, we kind of started working on a more focused approach to deal with the wound to try and provide relief focused on pain as one of the predictors of improvement.