Acquired perforating disease associated with chronic renal failure

Dermatological Manifestations in Patients With Chronic Kidney Disease: A Review

Chronic kidney disease (CKD) is a progressive disease and has multiple clinical manifestations; when CKD reaches the end stage, at least one cutaneous manifestation appears due to some increased toxin levels or a constant proinflammatory state. Nonspecific manifestations include pruritus, xerosis, pigmentation disorders, acquired ichthyosis, purpuric spots, and nail disorders. Some specific manifestations are bullous dermatoses, acquired perforating dermatoses (APD), eruptive xanthoma, access site infections, calcifying disorders, and nephrogenic systemic fibrosis (NSF). All these cutaneous changes negatively impact patients; early recognition and diagnosis of these dermatoses will make a difference in their quality of treatment. Exploring a patient's skin is fundamental to suspect some diseases and increased toxin levels; pruritus occurs when uremic toxins are raised, and nail disorders are associated with hypoalbuminemia. This review provides the clinician with information on the clinical manifestations that occur in CKD, including epidemiology, pathophysiology, clinical manifestations, diagnosis, histopathology, treatment, and life impact of the dermatoses in CKD.

Cutaneous manifestations of end-stage renal disease

Examination of the skin and nails can reveal many abnormalities in patients with end-stage renal disease that precede or follow initiation of dialysis treatment or kidney transplantation. This article focuses on specific and nonspecific cutaneous signs of end-stage renal disease, reviewing both banal and life-threatening conditions, including pruritus, perforating disorders, calcifying disorders, and bullous dermatoses. The pathogenesis, clinical findings, histologic findings, differential diagnosis, and treatment of these diseases are discussed. Cutaneous manifestations unique to kidney transplantation will not be covered. (J Am Acad Dermatol 2000;43:975-86.)

Acquired perforating disease: report of nine cases

BACKGROUND

A study of nine Guatemalan patients with acquired perforating disease associated with chronic renal failure, diagnosed at the Guatemalan Social Security Institute, General Hospital, during the period of January 1990 to March 1993, is presented (Table 1).

METHODS

A dermatological examination and skin biopsy were done on all patients.

RESULTS

Six of the patients were men and three were women; one case was associated with diabetes mellitus. Three of the patients were diagnosed as Kyrle-like acquired perforating disease, and the other six as perforating folliculitis. The lesions were predominantly located in the lower extremities with hyperkeratotic papules and nodules; some of these were accompanied by pruritus and Koebner's phenomenon.

CONCLUSION

The acquired perforating disease is a clinical cutaneous manifestation of chronic renal failure with or without treatment. The lesions can disappear spontaneously with stabilization of the renal damage.