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Arriaga Escamilla D, Lakhani A, Antony S, Salazar Villegas KN, Gupta M, Ramnath P, Murillo Pineda MI, Bedor A, Banegas D, Calderon Martinez E. Dermatological Manifestations in Patients With Chronic Kidney Disease: A Review. Cureus 2024; 16:e52253. [PMID: 38352109 PMCID: PMC10863542 DOI: 10.7759/cureus.52253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
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.
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Affiliation(s)
| | - Alisha Lakhani
- Medicine, Research MD, Vadodara, IND
- Medicine, Shantabaa Medical College, Amreli, IND
| | - Sneha Antony
- Pharmacology, K S Hegde Medical Academy, Mangalore, IND
| | | | - Manasvi Gupta
- General Practice, Jawaharlal Nehru Medical College, Aligarh, IND
| | | | | | - Alexandra Bedor
- Internal Medicine, Instituto Salvadoreño del Seguro Social, San Salvador, SLV
| | - Douglas Banegas
- General Medicine, Universidad Nacional Autonoma de Honduras, San Pedro Sula, HND
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Hydration, barrier of skin and uremic pruritus in patients undergoing hemodialysis: A pilot investigation. Nephrol Ther 2022; 18:498-505. [DOI: 10.1016/j.nephro.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/05/2022] [Accepted: 05/28/2022] [Indexed: 11/24/2022]
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ALTUN E. Hemodiyaliz Tedavisine Devam Eden Hastalarda Cilt Lezyonlarının Sıklığı ve İlişkili Faktörler: Tek Merkez Deneyimi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1096741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Rekik M, Sellami K, Baklouti M, Bahloul E, Mesrati H, Turki H. [Repigmentation in vitiligo universalis triggered by hemodialysis]. Nephrol Ther 2021; 17:473-474. [PMID: 34059479 DOI: 10.1016/j.nephro.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
Vitiligo is an acquired depigmenting disorder. Vitiligo universalis is a rare form responsible for significant aesthetic damage. To date, the exact pathogenesis remains unknown. Its treatment, a real challenge, consists rather in removing the still pigmented areas. We report a case of a patient followed for stable vitiligo universalis from an early age who presented with repigmentation shortly after initiation of hemodialysis.
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Affiliation(s)
- Mariem Rekik
- Service de dermatologie, CHU Hédi Chaker, route de Gremda, immeuble Mariem 2, appartement 3-1, Sfax, Tunisie.
| | - Khadija Sellami
- Service de dermatologie, CHU Hédi Chaker, route de Gremda, immeuble Mariem 2, appartement 3-1, Sfax, Tunisie
| | - Massara Baklouti
- Service de dermatologie, CHU Hédi Chaker, route de Gremda, immeuble Mariem 2, appartement 3-1, Sfax, Tunisie
| | - Emna Bahloul
- Service de dermatologie, CHU Hédi Chaker, route de Gremda, immeuble Mariem 2, appartement 3-1, Sfax, Tunisie
| | - Hela Mesrati
- Service de dermatologie, CHU Hédi Chaker, route de Gremda, immeuble Mariem 2, appartement 3-1, Sfax, Tunisie
| | - Hamida Turki
- Service de dermatologie, CHU Hédi Chaker, route de Gremda, immeuble Mariem 2, appartement 3-1, Sfax, Tunisie
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Asayesh H, Peykari N, Pavaresh-Masoud M, Esmaeili Abdar M, Tajbakhsh R, Mousavi SM, Djalalinia S, Noroozi M, Qorbani M, Mahdavi-Gorabi A. Dermatological manifestations in hemodialysis patients in Iran: A systematic review and meta-analysis. J Cosmet Dermatol 2018; 18:204-211. [PMID: 29577562 DOI: 10.1111/jocd.12531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dermatologic complications are common in patients with end-stage renal disease and also have a high diversity. OBJECTIVES This meta-analysis reviews prevalence of dermatological manifestations among hemodialysis patients in Iran. MATERIALS AND METHODS Using PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS as the main international electronic data sources, and Iran-Medex, Irandoc, and Scientific Information Database, as the main domestic databases with systematic search capability, we systematically searched surveys, papers, and reports on the prevalence of dermatological manifestations (until February 2016). Heterogeneity of reported prevalence's between studies was assessed using the Q test; overall prevalence of dermatological manifestations was estimated using random-effect meta-analysis model. RESULTS We found 1229 records; from them, a total of eight studies comprising 917 hemodialysis patients were included. In all of studies, skin discoloration, pruritus and xerosis have the highest prevalence. According to random-effect meta-analysis model, the pooled prevalence of skin discoloration, pruritus, ecchymosis, xerosis, and half-and-half nail in hemodialysis patients were 48.03% (95% CI: 45.09-51.01), 52.85% (95%CI: 49.23-56.47), 19.88 (95% CI: 17.57-22.19), 51.14% (95% CI: 48.25-54.02), and 18.50% (95% CI: 16.0-21.0), respectively. CONCLUSIONS his study shows that the prevalence of dermatological manifestations seems high among the hemodialysis patients in Iran, and skin discoloration, pruritus, and xerosis are more common.
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Affiliation(s)
- Hamid Asayesh
- Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Niloofar Peykari
- Iranian Non-communicable Diseases Committee, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Mohammad Esmaeili Abdar
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Ramin Tajbakhsh
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Shirin Djalalinia
- Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Chronic Disease Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Armita Mahdavi-Gorabi
- Department of Basic and Clinical Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Risk of Skin Diseases in Maintenance Hemodialysis. Transplant Proc 2018; 50:1616-1620. [PMID: 30056869 DOI: 10.1016/j.transproceed.2018.02.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/19/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Maintenance hemodialysis (HD) patients are potential transplant recipients. One of the most common cancers in the population of kidney recipients is skin neoplasm. Skin infections are also of a particular importance. In this population, especially in patients on the transplant waiting list, full dermatological examination, including dermatoscopy, should be carried out routinely. MATERIALS AND METHODS The research was comprised of 105 HD patients (57 men, 48 women) with a mean age of 60.8 (range 25-94) years. The patients' skin condition was assessed and a dermatoscopic examination was performed. We compared the incidence of skin diseases in the two subpopulations: HD patients (n = 89) and HD patients active on the transplant waiting list (n = 16). RESULTS Bacterial, fungal, and viral infections in the group of HD patients occurred in 24.7%, 14.6%, and 6.7% of patients, respectively. In HD patients on the waiting list, bacterial skin diseases were reported in 12.5% of patients, and neither fungal nor viral infections were noticed. Malignant skin lesions and precancerous conditions, such as basal cell carcinoma and keratosis actinic, developed in 4.5% and 3.4% of the HD patients. These malignancies did not occur in HD patients on the waiting list. The results show proper qualification for transplantation in maintenance HD patients before the waiting list. In the group of dialysis patients, 67.4% required dermatological care, while in the HD waiting group only 12.5% required dermatological care. CONCLUSIONS The presented results prove the necessity of performing dermatological examinations on HD patients. Some dermatological skin lesions, if not diagnosed and treated, could progress to cancer after organ transplantation.
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Coulibaly G, Korsaga-Somé N, Fomena DFY, Nagalo Y, Karambiri AR, Bassolet A, Kafando H, Traoré A, Lengani A. [Cutaneous manifestations in patients on chronic hemodialysis in a developing country]. Pan Afr Med J 2016; 24:110. [PMID: 27642449 PMCID: PMC5012827 DOI: 10.11604/pamj.2016.24.110.8639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 11/25/2022] Open
Abstract
Our study aims to highlight the most common skin disorders in patients on chronic hemodialysis at the University Hospital Yalgado Ouédraogo (CHU-YO) in Ouagadougou. The study, of transverse type descriptive, carried out of September 15 to December 31, 2014, is unrolled with the CHU-YO. This descriptive transversal study was conducted at the CHU-YO from September 15 to December 31, 2014. It involved patients who had been on chronic dialysis for at least 3 months. The frequency of hemodialysis sessions was one every five days. The significance level of statistical tests was defined as the probability p ≤ 0.05. Eighty-five patients (61.1% men and 38.9% women) with an average age of 42.1 years were included in the study. The mean duration of hemodialysis was 31.9 months. The success rate of biological examinations varied from 7,4 to 85,3%. Eighty patients (85,3%) had at least one cutaneous manifestation. Cutaneous xerosis (67.4%), pruritus (45.3%), and hyperpigmentation (23.2%) were the most frequent skin manifestations that may be specific of hemodialysis. Guttate hypomelanosis (11.6%), prurigo (11.6%) and folliculitis (8.4%) were the main non-specific skin manifestations. Skin involvement was frequent but did not seem related to seniority in hemodialysis. In Ouagadougou, bad hemodialysis conditions and a hot, dry environment promote such conditions, especially xerosis and pruritus. A better subvention of health care could help to reduce the prevalence of skin diseases and to improve the quality of life of our patients on chronic hemodialysis.
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Affiliation(s)
- Gérard Coulibaly
- Service de Néphrologie et Hémodialyse, Ouagadougou, Burkina Faso; Université de Ouagadougou, Burkina Faso
| | - Nina Korsaga-Somé
- Université de Ouagadougou, Burkina Faso; Service de Dermatologie-Vénérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | | | - Yacouba Nagalo
- Service de Dermatologie-Vénérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | | | - Alban Bassolet
- Service de Dermatologie-Vénérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Hyacinthe Kafando
- Service de Dermatologie-Vénérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Adama Traoré
- Université de Ouagadougou, Burkina Faso; Service de Dermatologie-Vénérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Adama Lengani
- Service de Néphrologie et Hémodialyse, Ouagadougou, Burkina Faso; Université de Ouagadougou, Burkina Faso
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Affiliation(s)
- Sandeep Arora
- Department of Dermatology, Army College of Medical Sciences and Base Hospital, Delhi, India
| | - Ajay Malik
- Department of Pathology, Army College of Medical Sciences and Base Hospital, Delhi, India
| | - Anil Balki
- Department of Dermatology, Army College of Medical Sciences and Base Hospital, Delhi, India
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Reszke R, Pełka D, Walasek A, Machaj Z, Reich A. Skin disorders in elderly subjects. Int J Dermatol 2015; 54:e332-8. [DOI: 10.1111/ijd.12832] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 07/22/2014] [Accepted: 07/26/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Radomir Reszke
- Department of Dermatology, Venereology and Allergology; Wroclaw Medical University; Wroclaw Poland
| | - Dorota Pełka
- Department of Dermatology, Venereology and Allergology; Wroclaw Medical University; Wroclaw Poland
| | - Angela Walasek
- Department of Dermatology, Venereology and Allergology; Wroclaw Medical University; Wroclaw Poland
| | - Zbigniew Machaj
- Department of Internal Diseases, Geriatrics and Allergology; Wroclaw Medical University; Wroclaw Poland
| | - Adam Reich
- Department of Dermatology, Venereology and Allergology; Wroclaw Medical University; Wroclaw Poland
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Mourad B, Hegab D, Okasha K, Rizk S. Prospective study on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals, Egypt. Clin Cosmet Investig Dermatol 2014; 7:313-9. [PMID: 25419152 PMCID: PMC4235205 DOI: 10.2147/ccid.s70842] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction Chronic hemodialysis patients experience frequent and varied mucocutaneous manifestations in addition to hair and nail disorders. The aim of this study was to evaluate the prevalence of dermatological changes among patients with end-stage renal disease under hemodialysis in a hemodialysis unit in Tanta University hospitals over a period of 6 months, and to evaluate the relations of these dermatological disorders with the duration of hemodialysis as well as with different laboratory parameters in these patients. Patients and methods Ninety-three patients with end-stage renal disease on regular hemodialysis (56 males and 37 females) were selected and included in this cross-sectional, descriptive, analytic study. Their ages ranged from 18–80 years. All patients underwent thorough general and dermatological examinations. Laboratory investigations (complete blood counts, renal and liver function tests, serum parathormone levels, serum electrolytes, alkaline phosphatase, random blood sugar, and Hepatitis C virus (HCV) antibodies) were evaluated. Results This study revealed that most patients had nonspecific skin changes, including xerosis, pruritus, pallor, ecchymosis, hyperpigmentation, and follicular hyperkeratosis. Nail and hair changes were commonly found, especially half and half nail, koilonychia, subungal hyperkeratosis, melanonychia, onychomycosis, and brittle and lusterless hair. Mucous membrane changes detected were pallor, xerostomia, macroglossia, bleeding gums, aphthous stomatitis, and yellow sclera. There was a significant positive correlation between the presence of pruritus and serum parathormone level. There was a significant negative correlation between the presence of mucous membrane changes and hemoglobin level. Conclusion Nonspecific mucocutaneous manifestations are common in patients on hemodialysis, particularly xerosis, dyspigmentation, and pruritus. Early and prompt recognition and treatment of dermatological conditions in patients on dialysis may improve their quality of life.
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Affiliation(s)
- Basma Mourad
- Dermatology and Venereology Department, Tanta University, Tanta, Egypt
| | - Doaa Hegab
- Dermatology and Venereology Department, Tanta University, Tanta, Egypt
| | - Kamal Okasha
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Dahbi N, Hocar O, Akhdari N, Amal S, Bassit N, Fadili W, Laouad I. [Cutaneous manifestations in hemodialysis patients]. Nephrol Ther 2014; 10:101-5. [PMID: 24508001 DOI: 10.1016/j.nephro.2013.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/21/2013] [Accepted: 10/13/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hemodialysis patients have frequent and various cutaneous manifestations of often hypothetical pathogenesis. Chronic renal failure (CRF) presents with an array of cutaneous manifestations. The objective was to evaluate the prevalence and nature of cutaneous lesions associated with CRF patients on hemodialysis patients. PATIENTS AND METHODS Transversal and observational study of 53 patients with CRF on regular hemodialysis. RESULTS There were 28 women and 25 men. Their mean age was 44 year-old. All patients had cutaneous manifestations and 64% complained of dermatological signs. Cutaneous xerosis and pigmentation disorders were found in 96 and 94% of patients, respectively. Other manifestations were pallor (41%), pruritus (20.7%), a diffuse hair loss (35.8%) and nails changes (66%). COMMENTS Cutaneous manifestations in hemodialysis patients are frequent polymorphous. Their incidence varies from 50 to 100% of the series. Their knowledge deserves a proper management by both dermatologists and nephrologists to improve the life quality of hemodialysis patients.
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Affiliation(s)
- Noama Dahbi
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc.
| | - Ouafa Hocar
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Nadia Akhdari
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Said Amal
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Nora Bassit
- Service de néphrologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Wafaa Fadili
- Service de néphrologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Inas Laouad
- Service de néphrologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
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