Cutaneous Manifestations in Egyptian Patients with Chronic Renal Failure on Regular Hemodialysis

Background. Hemodialysis patients experience frequent and various cutaneous manifestations of often hypothetical pathogenesis. Chronic renal failure (CRF) presents with an array of cutaneous manifestations. Objective. To evaluate the prevalence and nature of cutaneous lesions, associated with CRF patients on hemodialysis in Egyptian patients. Patients and methods. One hundred patients with CRF on regular hemodialysis from nephrology units were examined for cutaneous changes. Specific investigations like skin biopsy, culture and sensitivity for bacterial infections, potassium hydroxide mount and fungal culture were done when indicated. Results. All patients included in this study had at least one cutaneous manifestation attributable to CRF. The most prevalent findings was pruritus (55%), followed by xerosis (54%), hyperpigmentation (54%) and pallor (45%). Other cutaneous manifestations were wrinkles (40%), fungal infections (33%), ecchymosis (27%), dermatitis (23%), yellow face (22%), Petichae (19%), delayed wound healing (11%), follicular hyperkeratosis (10%), bacterial infections (5%), viral infections (2%) and uremic frost (1%). Nail changes were koilonychia (39%), half and half nail (28%), splinter hemorrhages (16%), Muehrcke’s lines (12%), subungual hyperkeratosis (10%), Mees’ lines (8%), brown nail (6%), onycholysis (3%) and Beau’s lines (2%). Hair changes were brittle and lusterless hair (47%), sparse scalp hair (46%) and sparse body hair (27%). Oral changes were macroglossia (42%), xerostomia (35%), coated tongue (27%), angular cheilitis (15%), ulcerative stomatitis (9%), acquired perforating dermatosis (3%). Some rare manifestations of CRF like calciphylaxis (2%) were seen. There was no association between any particular etiology of CRF and certain mucocutaneous, nail or hair abnormalities. Conclusion. At least one cutaneous manifestation is found in all CRF patients. The most prevalent findings were pruritus followed by xerosis and hyper-pigmentation then pallor. With the advent of hemodialysis, the life expectancy of these patients has increased giving time for more and newer cutaneous changes to manifest. The aetiology of CRF does not affect the development of cutaneous, nail or hair abnormalities.