Cutaneous changes in patients with chronic renal failure on hemodialysis

Context: A number of skin diseases can be observed in chronic renal failure (CRF). Their incidence have changed in different series. Objective: To compare the prevalence of cutaneous changes in CRF undergoing hemodialysis (HD) with healthy persons and to study the potential relationship with various parameters in the patients. Materials and methods: The study comprised one hundred patients with CRF under regular HD as well as one hundred healthy control subjects of matched age and sex. Both groups were subjected to full history and thorough skin examination. Results: Numerous skin lesions (at least one in each patient) were detected in all patients examined. Of these patients, nail abnormalities were observed in 92%, xerosis in 87%, fungal infection in 68%, hyperpigmentation in 62%, pruritus in 51%, and paleness in 51%. The nail changes included absence of lunula (55%), half and half nail (51%), splinter hemorrhages (36%), subungual hyperkeratosis (34%), onychomycosis (31%), koilonychia (19%), and onycholysis (9%). Oral changes were oral candidiasis (50%), xerostomia (40%), angular cheilitis (27%), and ulcerative stomatitis (18%). Specific cutaneous findings such as acquired perforating dermatosis, pseudoporphyria cutanea tarda, calciphylaxis, calcinosis cutis, and nephrogenic fibrosing dermopathy were not detected in any of the patients. In our study, when the patients were evaluated on the relationship between xerosis and pruritus, pruritus was found to be significantly increased parallel to the increase in the severity of xerosis. Conclusions: Xerosis and pruritus are common problems in HD-dependent patients. The early recognition of cutaneous signs can relieve suffering and decrease morbidity.