Renal disease can often trigger various skin conditions, and many medical and environmental factors will determine exactly what the patient experiences in these circumstances. Some skin conditions are associated with end-stage renal disease (ESRD) and uremia, while others are linked to organ transplants.

Common skin conditions in renal disease

While not commonly known, many patients with renal disease suffer from some type of skin disorder. In fact, roughly 50-100% of patients who are going through ESRD have at least one skin condition.

There are many different kinds of cutaneous conditions that could be implicated in renal disease, including: xerosis, pigment disorders, and pruritus.

Xerosis

Xerosis is a condition that is characterized by dry and rough skin. The patient usually experiences scaling, fissures, and general discomfort. About 50-75% of dialysis patients experience this particular skin issue. The cracks that can develop in the skin increases the chance for further infection from viruses or bacteria present in the environment.

Management of xerosis includes:

• Emollients: Moisturizers and emollients can soothe dry, scaly skin.
• Avoiding hot water and humidifiers: Too much hot water can further aggravate skin issues and cause excess drying.
• Bath oils: Bathing in natural oils can further moisturize the skin.
• Steroid cream: Medical creams can help alleviate itching.

Skin pigmentation disorders

Dialysis involves cleaning a patient’s blood when the body is unable to do so, and this process tends to increase the risk of skin pigmentation disorders. In fact, around 25-70% of patients who undergo dialysis experience skin pigmentation issues.  

A renal disease patient undergoing dialysis can experience:

• Hyperpigmentation: A condition that tends to develop in the areas of the skin exposed to sunshine.
• Changes in pallor: Pallor change can also be impacted by anemia.
• Yellow discoloration: This discoloration is the result of lipochrome and carotenoid deposition in the skin.

The chance of developing a skin pigmentation disorder increases the longer the patient has renal disease.

Pruritus or itching

One of the most common skin conditions related to renal disease is pruritus, or severe skin itching. About 50-90% of patents on dialysis experience pruritus, while around 15-49% of patients who have chronic kidney disease acquire the condition.

The itching tends to be at its worst during the night and can be all over the skin or localized in a specific region. The areas that are most likely to be affected are the stomach, head, back, or arms.

Management tools for pruritus include:

• Emollients: Creams and moisturizers with emollient properties can soothe the skin and temporarily ease itching.
• Ultraviolet phototherapy: Exposing the skin to narrow band and broadband UVB is most effective.
• Activated charcoal and nalfurafine: Both products may show some relief for skin itching; however, charcoal can induce nausea in some patients.

Other factors that trigger skin issues

A patient can develop a skin condition that is triggered by certain medications following organ transplant surgery.

To help a new organ settle in the body, the patient may be given immunosuppressive medicines that can cause cushingoid changes, which are the results of excess cortisol hormone. One symptom occurs in the face and makes the patient’s face resemble the moon.

A suppressed immune system due to viral infections, fungal infections, bacterial infections, and parasitic infections can also trigger skin issues. Renal disease patients tend to be more prone to infections, thus these patients are at a greater risk of developing skin-related symptoms.

References:

• http://parkhurstexchange.com/clinical-reviews/ct_02_vol15
• http://emedicine.medscape.com/article/1094846-overview
• http://www.dermnetnz.org/dermatitis/dry-skin.html
• http://www.ijdvl.com/article.asp?issn=0378-6323;year=2006;volume=72;issue=2;spage=119;epage=125;aulast=Udayakumar