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Box 1.  

Skin Disorders in Patients With Chronic Kidney Disease

Skin Problems in Chronic Kidney Disease: Acquired Perforating Dermatosis


Acquired Perforating Dermatosis

Acquired perforating dermatitis (APD, also known as Kyrle disease) has a prevalence of approximately 10% in dialysis populations and occurs predominantly in African Americans and patients with diabetes mellitus.[111,112] APD is also associated with other entities such as hepatic disease, thyroid illnesses, malignancies, scabies and AIDS. APD is usually characterized by a linear confluence of papules with a central, oystershell-like keratotic plug on the trunk, proximal extremities, scalp and face.[111,112] Lesions are red or pink in white patients, and hyperpigmented in black patients. APD can initiate intense pruritus with secondary development of scratch marks (Koebner phenomenon). The origin of APD lesions is not known; suspected causes include an inflammatory skin reaction secondary to the presence of uremic toxins, uric acid deposits or scratching-induced trauma.[111,112] Histological changes include the presence of epidermal invaginations with a central, basophilic, keratotic plug, uric acid and calcium hydroxyapatite deposits and chronic inflammatory granulomas.[112]

Treatment of APD is often frustrating as lesions can persist and chronic scars can develop. Lubricants, steroids, keratolytics, vitamin A, cryotherapy, UVB therapy and oral or topical isotretinoin preparations have all been tried with variable degrees of success.[111,112]

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