A virtual pediatric dermatology student-run clinic was initiated during the COVID-19 pandemic, when in-person educational opportunities were limited. The clinic's aim is to provide high-quality dermatologic care to a diverse, underserved pediatric patient population while teaching trainees how to diagnose and manage common skin conditions. In our initial eight sessions, we served 37 patients, predominantly those with skin of color, and had a low no-show rate of 9.8%. This report describes the general structure of the clinic, goals, and the patient population to provide an overview of our educational model for those interested in similar efforts.

Calciphylaxis is a rare life-threatening disorder characterized by skin necrosis due to calcium deposition within small- and medium-sized vessels and subsequent thrombosis leading to tissue ischemia.1,2 Though the exact pathogenesis of calciphylaxis is poorly understood, risk factors such as chronic kidney disease can promote calcium deposition and vascular calcification contributing to the disease process.3 This condition presents with poor healing, painful skin lesions, which initially may be confused with mimickers, such as cellulitis; peripheral vascular disease, warfarin necrosis, or vasculitis.4 While calciphylaxis is considered a rare disease predominantly affecting patients with chronic kidney disease on renal replacement therapy, there has been an increase in clinical awareness, which may be reflected in the increase in incidence.4 Despite calciphylaxis having a high morbidity and 1-year mortality as high as 80% in some cases,4 no randomized controlled trials examining longitudinal outcomes and treatment efficacy have been published.4 This report discusses 3 cases of early calciphylaxis diagnosis and treatment leading to rapid resolution and survival, highlighting the impact of timely recognition and intervention.

Background: Calciphylaxis is a rare thrombotic vasculopathy characterized by high morbidity and mortality. There is a paucity of studies examining longitudinal outcomes. Objective: To assess mortality, days spent in the hospital, and amputations in patients with calciphylaxis. Methods: A retrospective medical record review was conducted in 145 patients diagnosed with calciphylaxis at an urban tertiary care hospital from January 2006 to December 2018. Results: Six-month mortality was 37.2%, and 1-year mortality was 44.1%. Patients with nephrogenic calciphylaxis had worse survival than those with nonnephrogenic calciphylaxis (P = .007). This difference in survival disappeared when limiting mortality to deaths due to calciphylaxis. Age (P = .003) and end-stage renal disease (P = .01) were risk factors associated with 1-year mortality. Diabetes mellitus was associated with greater total hospitalization days (coefficient, 1.1; 95% confidence interval, 1.01-1.4); bedside debridement was associated with fewer hospitalization days (coefficient, 0.8; 95% confidence interval, 0.7-0.9). Amputations were not associated with any of the examined risk factors. The use of warfarin followed by a transition to nonwarfarin anticoagulation was associated with decreased hazard of death (P = .01). Limitations: Retrospective nature. Conclusions: Calciphylaxis remains a complex, heterogeneous disease. Mortality is lower in patients with nonnephrogenic disease. These findings may be incorporated during discussions regarding the goals of care to facilitate informed shared decision making.