Uremic skin alterations N18.9 N19.-

Skin symptoms that may occur in ESRD:

• Generalized pruritus (nephrogenic or uremic pruritus).
• "Preaging":
  • Elastosis actinica
  • Dry scaly skin (xerosis)
  • Decrease in sebaceous and sweat gland secretion
  • Increase in skin vulnerability, wound healing disorders.
• Pigmentation disorders:
  • Light brownish skin and mucous membrane pigmentation
  • Local or diffuse hyperpigmentation.
• Collagen metabolism disorders:
  • Reactive, perforating collagenosis
  • Hyperkeratosis follicularis et parafollicularis in cutem penetrans (M. Kyrle).
  • Folliculitis, perforating
  • Carpal tunnel syndrome, Dupuytren's contracture
  • Extensive fibrosis of the skin, subcutis and musculature
  • Nephrogenic systemic fibrosis
• Other, Skin disorders:
  • Nail changes(half nails)
  • Sensitivity to cold, Raynaud's phenomenon
  • Porphyria cutanea-like skin changes(pseudoporphyria)
  • Secondary oxalosis
  • Pseudo-Kaposi sarcoma
  • Cutaneous calciphylaxis (see also calcinosis cutis)
  • Panniculitis calcificans.
  • Dialysis: Bradykinin (BK) has been identified as a major mediator of hypersensitivity reactions in patients dialyzed with negatively charged membranes and concomitantly treated with angiotensin-converting enzyme(ACE) inhibitors.

50-100% of all patients with chronic renal insufficiency suffer from uremic skin changes. In Germany, about 57,000 patients are currently dependent on dialysis. Their number is rising. In uremic skin conditions, the dryness of the integument with ichthyosiform changes and often a permanent pruritus of varying severity are the main symptoms.

• Dialysis-induced pruritus is extremely distressing and particularly resistant to therapy. In the therapy of uremic pruritus in dialysis-induced terminal renal insufficiency, kidney transplantation has proven particularly effective. After successful transplantation the pruritus usually stops abruptly.
• If a transplantation is not possible at first, UV irradiation (UVB or high-dose UVA1) is the first choice therapy. Capsaicin (0.01-0.5% in a cream base or as a shaking mixture) is helpful at least temporarily in some cases.
• Dry skin can be treated with greasing creams or ointments (e.g. Ungt. emulsif. aq., Neribas fatty ointment, Ash base fatty ointment) and oil baths (e.g. Balneum Hermal oil bath, Oil bath Cordes).
• Antihistamines have only little value.
• Individual reports exist on thalidomide, morphine antagonists such as naltrexone (50 mg/day p.o.) and erythropoietin. S.a. Pruritus, renal.

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8. Tomson C et al (2003) Vascular calcification in chronic renal failure. Nephron Clin Pract 93: 124-130
9. Ulrich H et al (2004) Dialysis-associated skin changes. Dermatologist 55: 485-496