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| Fig. 38.1 Cutaneous findings. A, Tense vesicle on the dorsal hand of a patient undergoing renal dialysis. B, Half-and-half nails in a patient with chronic renal failure. |
Many of the skin changes described in patients with chronic renal failure are also found in patients with renal failure undergoing treatment with either peritoneal dialysis or hemodialysis. A high percentage of patients receiving dialysis complain of pruritus that may be severe. In some instances, the pruritus worsens with dialysis. Patients on renal dialysis may develop a bullous eruption similar to porphyria cutanea tarda (Fig. 38-1A). Acne has been described in association with dialysis and therapy with testosterone. Several perforating diseases are associated with chronic renal failure, with or without renal dialysis, including Kyrle’s disease, reactive perforating collagenosis, and perforating folliculitis. Some authors group all of the perforating diseases seen in these patients under one term—
acquired perforating dermatosis of chronic renal failure. The pathogenesis of these conditions is not understood. Dialysis patients may also develop cutaneous complications from this treatment, such as infections or contact dermatitis in the area of the peritoneal cannula or arteriovenous fistula.
Fuchs E, Lynfield Y: Dialysis acne,
J Am Acad Dermatol 23:125, 1990.
