Uraemic pruritus
• Itching is a common and distressing problem both in chronic kidney disease and in
those individuals receiving dialysis (60–90% of patients).
• Itch, whether intermittent or persistent, generalized or localized, may have a major
impact on quality of life, e.g. insomnia, depression.
• Pathogenesis is unclear, but accumulation of metabolic toxins and immunological
mechanisms may be involved. Dryness and impairment of integrity of the stratum
corneum may also play some part.
• Signs include excoriations, skin thickening (lichen simplex) caused by chronic rubbing,
and nodules.
• Always consider other causes of itching, including scabies; is anyone else in the family
itchy? Check for burrows between fingers and on genitalia.
Acquired perforating dermatosis
Synonym: reactive perforating collagenosis.
• Most often seen in diabetic patients with chronic kidney disease.
• Scratching may play some part in the pathogenesis.
• Itchy dome-shaped nodules erupt on the trunk and extensor surfaces of limbs, each with
a central depression filled with a crust.
• Skin biopsy shows collagen with other dermal components being eliminated through
transepidermal channels (‘perforations’).
• Often resolves spontaneously.
• Topical steroids, occlusion, UVB, or retinoids may be helpful.
Strategies worth trying include:
• Trim nails short to prevent damage to skin from scratching.
• Reduce the body temperature by using cool cotton clothing.
• Keep the room cool, particularly at night (avoid too many bedclothes).
• Avoid soap or excessive bathing (keep water temperature tepid).
• Copious emollients, as well as soap substitutes, to relieve dryness.
• Aqueous cream with 1% menthol.
• Occlusion with paste bandages such as Zipzoc®.