Uremic skin alterations N18.9 N19.-

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Dialysis Skin lesions; Skin changes uremic; Uremic dermatopathy

Definition
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Skin alterations occurring under long-term nerve insufficiency (especially in chronic dialysis situations).

Classification
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Skin symptoms that can occur in case of end-stage renal failure:

Occurrence/Epidemiology
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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.

Clinical features
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In the case of uremic skin symptoms, the dryness of the integument with ichthyosiform changes as well as a permanent pruritus with varying degrees of severity are in the foreground.

Therapy
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Treatment of renal insufficiency by nephrologists.
  • 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.
Regarding the treatment of the special skin symptoms occurring during dialysis, see there.

Literature
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  1. Altmeyer P et al (1990) Skin diseases. In: Franz HE (Ed.) Blood purification methods. Thieme, Stuttgart New York, S. 297-305
  2. Altmeyer P et al (1982) Skin changes in long-term dialysis patients. Dermatologist 33: 303-309
  3. Crawford GH et al (2002) Skin signs of systemic disease: an update. Adv Dermatol 18: 1-27
  4. Doctoroff A et al (2003) Protracted calciphylaxis, Part I. Cutis 71: 473-475
  5. Hubbard V et al (2003) Scleromyxoedema-like changes in four renal dialysis patients. Br J Dermatol 148: 563-568
  6. Knable AL Jr (2002) Cutaneous nephrology. Dermatol Clin 20: 513-521
  7. Salmhofer W et al (1995) Cutaneous calciphylaxis in chronic renal failure. Dermatologist 46: 726-731
  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

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020