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. 2021 Jun 24;314(6):515–525. doi: 10.1007/s00403-021-02264-5

Table 1.

Characteristics of the studies included in the systematic review

First author (publication year) No of cases Underlying disease Location of lesion(s) Maximal diameter of the largest lesion [cm] Treatment frequency, range Median (range) treatment duration (months) Median (range) time to the first clinical improvement (months) Outcomesa Median (range) follow-up (months)
Topical sodium thiosulfate
 Abbott [59] 1 IV calcium infusion extravasation Hand 4.0 Twice a day 10 weeks 1 CR 6
 von Hodenberg [32] 6 SSc × 6 Fingers 0.4 Once a day 8 (range 2–13) N/R

2/6 CR,

4/6 PR

 N/R
 Bhari [42] 1 EB Hands, feet 0.5 Twice a day 3 N/R PR 3
Ma [31] 28 SSc × 15, overlap × 4, UCTD × 4, SLE, CLE, JDM, RA, JRA Hands, feet, lower extremities, upper extremities N/R Twice or three times a day Mean 3.9 (range 0.3–24) Mean 4 (range 0.5–11)

2/28 CR, 17/28 PR, 7/28 NR,

2/28 UR

 N/R
 Karthik [40] 1 Werner syndrome Lower extremity 13.0 N/R 9 5 PR 15
 Tajalli [39] 1 CREST Finger 0.3 Three times a day 3 2

CR

pain free

  > 36
 Topham [38] 1 JDM Lower extremity N/R Three times a week 2 N/R PR N/R
 García-García [41] 1 IV calcium infusion extravasation Upper extremity N/R Twice a day 6 3

CR

pain free

regained mobility

 N/R
 Jost [18]b 3 TC × 2, HHS Buttock, lower extremity, upper extremity 20 Once a day 13 (range 4–13.4) 4 (range 2–7)

1/3 CR,

2/3 PR

pain reduction × 1

 14 (range 7–14)
 Urretavizcaya [33] 2 IV calcium infusion extravasation × 2 Upper extremity N/R N/R N/R N/R

PR

regained mobility

 N/R
 Pagnini [48] 1 JDM Lower extremities, upper extremities N/R Once a day 9 N/R PR N/R
 Perez-Moreno [46] 1 IV calcium infusion extravasation Upper extremity N/R N/R N/R 2 weeks

CR

pain free

regained mobility

 4
 Wolf [47] 1 SLE Lower extremities 12.5 Twice a week N/R 6

PR

pain reduction

 10
Intralesional sodium thiosulfate
 López-Sundh [43] 1 SSc Axillae 3.0 Once a month 3 N/R

CR

pain reduction

 N/R
 Olesen [17] 29 SSc × 26, overlap × 2, DM N/R 65.0 Once a week 4 weeks N/R 13/29 CR, 13/29 PR, 3/29 NR (12–16 weeks)
 Winter [22] 5 DM × 2, SSc × 2, morphea N/R 2.0 Once a month 3 N/R 1/5 CR, 3/5 NR, 1/5 UR 3
 Tonial [21] 7 SSc × 6, DM Earlobe, fingers, hands, lower extremities, upper extremities N/R Once or twice a month 1.5 (range 1–3.5) N/R

NR

4/5 pain reduction

 N/R
 Goossens [10] 2 DM, TC Buttock, upper extremity 20.4 Once or twice a week 16.5 (12–21) 2.5 (2–3)

2/2 PR

2/2 pain reduction

 16.5 (12–21)
 Gunasekera [36] 1 SLE Abdomen, lower extremities, upper extremity N/R Two or three sessions N/A N/R CR 16
 Oh [19] 1 JDM Lower extremity 2.4 Once a month 6 4

PR

pain reduction

 N/R
 Baumgartner-Nielsen  [4] 6 SSc × 5, NSF Buttocks, fingers, lower extremities, upper extremity 8.5 Single session or once a week 1 week (3–4 weeks)c 1

2/6 CR, 4/6 PR

6/6 pain reduction

 12 weeks
 Smith [37] 1 DM Finger 0.4 Once a week 2 weeks 1 week

CR

pain free

 3 weeks
Co2 laser
 Cannarozzo [35] 5 scrotal calcinosis Scrotum N/R Single session N/A N/R 5/5 CR 7 years (range 2–10)
 Aristazabal [44] 1 milia-like calcinosis Forehead N/R Single session N/A N/R PR 6
 Weig [49] 1 SCN Finger  > 0.6 Single session N/A N/R CR 18
 Zarate [45] 1 JDM Fingers, hand, upper extremity 1.0 Single session N/A N/R

PR

pain free

 6
 Kutlubay [50] 1 trauma Lower extremity 0.4 Single session N/A 2 weeks CR 3
 Joo [51] 1 SCN Earlobe 2.0 Single session N/A N/R CR 5 weeks
 Chamberlain [52] 1 CREST Fingers N/R Single session N/A 6 weeks PR  > 36
 Paek [23] 1 SCN Eyelid N/R Single session N/A N/R CR 15
 Bottomley [13] 6 SSc × 6 Fingers N/R Single session N/A (8–16 weeks)

12/21 lesions CR, 5/21 lesions PR, 4/21 lesions NR

3/6 pain free

2/6 pain reduction

  > 10
Er:YAG laser
 Meissner [53] 1 CREST Buttocks  < 2.0 Single session N/A 2 weeks CR 14 weeks
Diode laser
 Wollina [54] 1 scrotal calcinosis Scrotum N/R Single session N/A N/R CR N/R
Picosecond laser followed by CO2 laser
 Abrouk [55] 1 DM Hips N/R Three sessions N/R N/R CR N/R
ESWL
 Delgado-Márquez [57] 1 Overlap Lower extremity 8.0 Once every 2 weeks N/R N/R

PR

pain reduction

 N/R
 Sultan-Bichat [5] 8 CVI × 4, SSc × 3, DM Fingers, lower extremities N/R Once every 3 weeks 9 weeks N/R

1/8 CR, 4/8 PR, 2/8 NR, 1/8 UR

3/8 pain free

2/8 pain reduction

 6
 Chan [56] 1 JDM Lower extremity, upper extremity 1.5 Single session N/A N/R

NR

pain reduction

  > 6
 Sparsa [11] 1 CREST Lower extremities  < 20 Once a month 3 2 weeks PR N/R
ESWL followed by intralesional sodium thiosulfate
 Pavlov-Dolijanovic [58] 1 SSc Lower extremities 5.0 Once a week 22 weeks N/R

PR

pain reduction

 N/R
Picosecond laser followed by topical sodium thiosulfate
 Eleryan [34] 2 JDM, DM Buttocks, lower extremity 5.0 Twice a week/month 6 N/R

2/2 PR

1/2 pain reduction

 N/R

CLE cutaneous lupus erythematosus, CO2 carbon dioxide, CR complete response, CVI chronic venous insufficiency, DM dermatomyositis, EB epidermolysis bullosa, Er:YAG erbium-doped yttrium aluminium garnet, ESWL extracorporeal shockwave lithotripsy, HHS hyperphosphatemia hyperostosis syndrome, IV intravenous, JDM juvenile dermatomyositis, N/A not applicable, n of patients number of patients, NSF nephrogenic systemic fibrosis, N/R not reported, PR partial response, RA rheumatoid arthritis, JRA juvenile rheumatoid arthritis, SCN subepidermal calcified nodule, SLE systemic lupus erythematosus, SSc systemic sclerosis, STS sodium thiosulfate, TC tumoral calcinosis, UR unknown response

aPain and mobility improvement were assessed in patients that experienced pain and reduced range of motion before local treatment

bOne patient in this study was previously described by Ratsimbazafy et al.[20]

cCalculated only for the patients who underwent multiple sessions