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Skin Problems and Dialysis

Some patients with chronic kidney disease (CKD) who are on dialysis may notice some unpleasant changes in their skin. Three skin conditions that sometimes affect those on dialysis include:

  1. itching (pruritus)
  2. dry skin (xerosis)
  3. skin discoloration (hyperpigmentation)

Learning why these skin conditions happen, and what can be done to prevent or ease the problem, can help keep skin as healthy as possible.

Itching (pruritus)

A majority of dialysis patients, whether they do hemodialysis or peritoneal dialysis, may experience itching at some point. Some feel itchy all the time, while for others it comes and goes. Many say itching is worse during or just after treatment. For some people the itching is in one area, while others feel itchy all over. While there have been studies to understand why dialysis patients experience itching, there is no exact cause or solution for every patient.

Here are the most common reasons for itching and what may be done to help ease it. Many of the solutions are easy and have no side effects, so they may be worth a try. Try to avoid scratching an itch so you won’t break the skin. If this happens, keep the area clean to prevent germs from causing an infection. Before trying any treatment you should always discuss it with your doctor.

Controlling phosphorus can help prevent itching

A common cause of itching is a high level of phosphorus in the body. Since dialysis does not effectively remove phosphorus, a renal diet that limits foods high in phosphorous is prescribed. In addition to controlling how much phosphorus is in your renal diet, remember to take phosphorus binders with every meal and snacks to help prevent or stop itching. Try to maintain a phosphorus level at 5.5 or less.

Staying on dialysis for your full treatment time is also recommended. While dialysis doesn’t remove all the phosphorus from the blood, it does remove some of it as well as other wastes and toxins.

Allergies

Sometimes itching is caused by allergies. If you notice itching occurs at the beginning of dialysis treatments, you could have an allergy to the blood tubing, dialyzer (artificial kidney), the type of heparin being used or other elements associated with the treatment. Let your doctor or nurse know so changes can be made.

Itching can also be a symptom of allergies to products you use everyday. Even if you’ve never had an allergic reaction to a product before, you may suddenly develop sensitivity.

Antihistamines and itch-relieving creams

Antihistamines are used to treat allergies and have helped to relieve itching. You’ll need to check with your doctor to make sure trying these products will be okay for you. Some antihistamines include: diphenhydramine (Benadryl®), hydroxyzine (Atarax®, Vistaril®) or chlorpheniramine (Aller-Chlor®, Chlor-Trimeton® Allergy, Teldrin®).

There are also products that are not indicated to relieve itching; however, some people have found them helpful. Capsaicin cream (Zostrix®, Capzasin-P®, Icy Hot®,) is made from the substance that makes chili peppers hot. Generally used as a pain reliever, capsaicin cream is said to relieve itching by deadening nerve impulses. When first using capsaicin cream most people feel a burning or stinging sensation where it is applied. Usually this feeling lessens or stops after repeated use.

Skin care products such as witch hazel and creams with lanolin or camphor may also help. Ask your pharmacist for other recommendations and be sure to check with your doctor before using any product.

Can sunlight stop itching?

Some people report that getting sunlight or ultraviolet (UV) light treatments in a doctor’s office or treatment center helps lessen itching. UV light, whether from the sun or through treatments, changes the chemicals on the skin, which can help certain skin problems. Because sunlight varies from day to day, phototherapy with artificial light in a treatment center is easiest to perform. One report showed that about 90% of patients who got eight UVB phototherapy treatments had relief from itching for one to six months.

Dry skin (xerosis)

Dry skin is also a common condition for patients with end stage renal disease. Kidney failure may make changes in the sweat glands and oil glands, which causes the skin to dry out. Dry skin can lead to infections and can cause skin wounds to heal slower than they should. Dry skin can also cause itching.

How do I treat dry skin?

To prevent or treat dry skin, avoid long, hot showers or baths as they can dry the skin even more. Choose your soaps carefully. Look for soaps that have natural, pure ingredients without harsh perfumes and chemicals. A moisturizing soap for sensitive skin can be a good choice. There are also bath products made with oatmeal created for dry, itchy skin that can be found at drug stores.

Apply a moisturizing, high-water content gel, lotion or cream to the body right after bathing, while the skin is still damp. Avoid creams or lotions with alcohol. Ask your doctor or pharmacist about dry skin treatments that are available. You may have to try a few products before you find one that works best for you.

Skin discoloration (hyperpigmentation)

Many reported cases of discolored skin, or hyperpigmentation, happen to people with end stage renal disease. One cause of skin discoloration is related to pigments called urochromes being retained in the skin. Normally these are excreted by healthy kidneys. Patients with this condition tend to have a grayish, almost metallic color skin.

Another discoloration is called uremic frost. This is a white, powdery substance left on the skin surface after sweat dries. Uremic frost is prevented by getting adequate dialysis.

Summary

Overall, the most common skin issues for people with chronic kidney disease and those on dialysis are itching and dry skin. Fortunately, there are many inexpensive, over-the-counter soaps, lotions and creams to try that may relieve these conditions. Talk to your health care team about suggestions on which products to try. Also, ask your doctor before trying any product, and keep your doctor informed about the condition of your skin in case adjustments need to be made in your treatments, or you need a prescription-strength medicine for your skin.


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