Calciphylaxis is a rare, life-threatening disorder that affects patients with End-Stage Renal Disease and who are on dialysis.  The mechanism of injury appears to involve the calcification and subsequent obstruction and thrombosis of small arterioles in the dermis and subcutaneous tissues, often in areas of increased adipose tissue, such as the thigh and abdomen.  Lesions appear as painful, purplish subcutaneous nodules that eventually erode into impressive deep ulcerations over time.  Ischemic necrosis appears to be intimately involved in the pathogenesis and likely related to the intense pain.  Risk factors, besides ESRD, include female sex, obesity, diabetes, and especially those patients who are concomitantly on warfarin, which appears to be a major risk factor, as well as high PTH levels (common in ESRD).  Treatment involves wound management modalities and pain control, as wounds are characteristically excruciatingly painful.