Praveen Kumar Kolla, Madhav Desai, Ram Mohan Pathapati,2 B. Mastan Valli, Suneetha Pentyala, G. Madhusudhan Reddy, and A. Vijaya Mohan Rao
International Scholarly Research Network
Volume 2012, Article ID 679619, 4 pages doi:10.5402/2012/679619
Hemodialysis.com Editor's Note: This is an open access article. Excerpt from article below.
One hundred and forty-three patients undergoing regular
hemodialysis twice a week were evaluated. Among them,
there were 113 male and 30 females (3.67 : 1). The mean
age of these patients was 43.8 ± 13.0 yrs (14–70).
The mean duration of dialysis was 23.0 ± 14.1 months.
Among the skin changes, pruritus accounted for 56%
of the total study population. It manifested even before
hemodialysis in 28 patients, and only 4 patients out of 81
showed significant improvement after hemodialysis.
Pruritus was found to be severe in diabetic patients (21/37).
Xerosis was observed in 52% of the study population.
Diffuse blackish hyperpigmentation was seen in 40% and was
predominant in sun-exposed areas.
53% of patients had skin infections, of
these fungal, bacterial and viral infections were 27.2%, 14.6%, and 11.2%, respectively.
Among the funga linfections onychomycosis, tinea versicolor and tinea cruris
(Figure 1) were the most common, and among the viral
infection herpes labialis and herpes zoster were common.
Kyrle’s disease (Figure 2) was observed only in 6.9% in our
Other skin manifestations include eczema 4.8%,
psoriasis 2.7%, and drug rash 2.1%.
Nail changes were observed in 46 patients of whom
27 patients had onychomycosis (Figure 3). Other changes
include discoloration, onycholysis, and splinter hemorrhages.
Hair changes were observed in 21.7%. Mucosal
changes were seen in 27.3%.
Pruritus was the most common skin manifestation observed
in our patients as compared to other studies.
Pruritus was found to be severe in diabetics.
Dry luster less skin could have contributed for such a high percentage in our study
Xerosis was found to be the second most common
manifestation which predominantly affected extensor surfaces
of forearms, legs, and thighs and was severe in diabetics
. Similar observation was noticed in previous studies
with a prevalence of 45–90% .
High dosage of diuretics, reduction in size of sweat glands, and excessive ultrafiltration
might be responsible for the above manifestation.
Emollients were prescribed to these patients and found to be effective.
Diffuse blackish hyperpigmentation was seen in 40%,
which was relatively high when compared to 20–22% in other studies .
This might be probably due to the failure
of kidneys to excrete beta-melanocyte stimulating hormone
and resultant melanin being deposited in basal layer as well
as superficial dermis.
The high incidence of infections might be due to diabetes, low albumin,
elevated intracellular calcium, acidosis, or repetitive vascular
procedures. Among the acquired perforating disorders, only
Kyrle’s disease was noticed, and others like perforating
folliculitis, and perforating collagenosis were not found in
Nail changes observed in our study were onychomycosis,
discolouration, onycholysis, and splinter hemorrhages. Hair
changes were observed with a sparse distribution over body
which included dryness and hair discoloration. Dryness
was possibly due to decreased sebum secretion. This was
high compared to 10–30% in other studies. The
reported incidence of oral mucosal changes in hemodialysis
patients was 27.3% compared to 90% in previous studies.
Changes observed in our study were xerostomia,
angular cheilitis, gingivitis, and uremic breath. Possible
causes include dehydration, mouth breathing, and high concentration
of urea, and failure to breakdown into ammonia.
In our study, pruritus, xerosis, and pigmentation were higher
among skin changes.
Recognition and management of some
of these dermatological manifestations vastly reduce the
morbidity and improve the quality of life.
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