Cutaneous Manifestations of ESRD

Abstract

SummaryA broad range of skin diseases occurs in patients with ESRD: from the benign and asymptomatic to the physically disabling and life-threatening. Many of them negatively impact on quality of life. Their early recognition and treatment are essential in reducing morbidity and mortality. The cutaneous manifestations can be divided into two main categories: nonspecific and specific. The nonspecific manifestations are commonly seen and include skin color changes, xerosis, half-and-half nails, and pruritus. The specific disorders include acquired perforating dermatosis, bullous dermatoses, metastatic calcification, and nephrogenic systemic fibrosis. This review article describes these conditions and considers the underlying pathophysiology, clinical presentations, diagnosis, and treatment options.

Wound Healing in Patients With Impaired Kidney Function

“…In rare cases, the use of phototherapy with ultraviolet B irradiation can be prescribed. 19,20 Calcific Uremic Arteriolopathy (Calciphylaxis)…”

Skin changes in chronic kidney disease

“…Xerosis affects approximately 85% of patients with ESRD, and it is particularly severe in the period before the initiation of dialysis therapy [2,3,10]. Although the pathomechanism is not entirely clear, similarly to other causes of dry skin it is known to involve a decreased amount of water in the stratum corneum, impaired sebum production and perspiration secondary to adnexal atrophy and altered composition of epidermal lipids.…”

“…Patients with CKD present with a variety of cutaneous symptoms ranging from minor skin conditions without a significant effect on normal functioning to severe disorders having a negative impact on the activities of daily living [2,3]. It is not uncommon for skin changes to be the first important sign of kidney disease, and nearly all patients with end-stage renal disease (ESRD) have at least one dermatological manifestation [4][5][6].…”

“…Chronic kidney disease may be associated with both specific and non-specific skin abnormalities [2][3][4][5]. Commonly observed non-specific changes which may also accompany other diseases and disorders (including arterial hypertension, lipid disturbances and hyperglycaemia) include: xerosis, pruritus, pigmentation disturbances, nail plate abnormalities (such as "half-and-half nails"), uraemic frost and gynaecomastia.…”

“…Commonly observed non-specific changes which may also accompany other diseases and disorders (including arterial hypertension, lipid disturbances and hyperglycaemia) include: xerosis, pruritus, pigmentation disturbances, nail plate abnormalities (such as "half-and-half nails"), uraemic frost and gynaecomastia. Specific skin changes in CKD include acquired perforating dermatosis, bullous diseases (such as porphyria cutanea tarda and pseudoporphyria), calcinosis and nephrogenic systemic fibrosis [2,3]. From the list given above, the most common skin changes occurring in CKD are: xerosis, pruritus, hyperpigmentation and bullous diseases -as well as perforating dermatoses and skin eruptions resulting from increased blood calcium levels [3][4][5][7][8][9].…”