CKD and Skin Diseases

Our appearance is something that each and everyone of us is very concerned about; one of the biggest concerns being our skin. We all have complained about some problem that we face with our skin at one time or the other, part of the very reason that the skincare industry is always booming is because of our daily obsession with our skin. While taking proper care of our skin is extremely important so is not obsessing over it in an unhealthy fashion. But, what about the many people who have fallen prey to unhealthy skin or have some kind of skin issues? That is precisely the whole point of our discussion today. Many internal diseases can manifest in the form of skin diseases; one of them being Chronic Kidney Disease (CKD). Let us discuss this issue in a bit more detailed fashion.

The color and luster of the skin is controlled by two specialized cells present in the epidermis of skin -keratinocytes and melanocytes. Melanin is a natural skin pigment secreted by MSH ( Melanin stimulating hormone) from the hypothalamus of the brain. Once kidney function gets compromised, the level of melanin in the blood rises, resulting in darker skin texture. The soft fatty tissue beneath the skin also controls the luster and glow of the skin. In patients with kidney disease, neurokinins do not work properly and skin luster diminishes. It is your kidneys and not the costly fairness creams that give you that facial glow.

There are a variety of dermatological diseases that are more commonly seen in patients with chronic kidney disease (CKD) and renal transplants than the general population. Some cutaneous diseases are clearly unique to this population. It is important for patients and physicians to recognize the manifestations of skin disease in renal disease to minimize and even prevent much of the morbidity associated with these conditions. If you have kidney disease, you won’t see early warning signs on your skin. 

Do you encounter itchy skin or dry skin?

Skin can become so dry that it – Becomes rough and scaly

When the kidneys fail to remove the waste products effectively from the blood, the waste products like phosphorus, calcium and even urea accumulate in the blood and promotes the skin itching and dryness.

Extremely dry skin is common among people with CKD. Skin can become so dry that it – Becomes rough and scaly, feels tight and cracks easily, develops fish-like scales. Extremely dry skin is common in people who have end-stage kidney disease, which requires dialysis or a kidney transplant. Itchy skin is another symptom which manifests among CK patients. Extremely itchy skin is a common symptom of advanced kidney disease. The itch can range from irritating to life-disrupting. Your skin may itch all (or most of) the time. Some people have itch on one area of their skin. The itch can also spread across most of your body. Scratch marks and other signs of scratching. When you scratch often, it affects your skin. You can develop: Raw, bleeding skin or sores, thick, leathery skin, firm, very itchy bumps. If nothing seems to relieve the itch, you may want to see a dermatologist. Some people who have end-stage kidney disease get relief from a treatment called UVB phototherapy.

Color changes to your skin Is a common occurrence among people with kidney disease. When the kidneys stop working as they should, toxins build up in your body. This build-up can cause color changes to the skin. You may see any of the following: An unhealthy pale color, gray hue, yellowish color, areas of darkened skin, yellowish, thick skin with bumps and deep lines, cysts and spots that look like whiteheads. The last two develop when you’ve had itchy skin for a long time and scratch often. Nail changes. Kidney disease can affect the appearance of your fingernails, toenails, or both. People who have advanced kidney disease can develop – A white color on the upper part of one or more nails and a normal to reddish brown color below, pale nails, white bands running across one or more nails (Muehrcke’s nails). Because your nails reveal a lot about your health, see your doctor if you notice any changes to your fingernails or toenails.

Swelling is the most common occurrence among kidney disease patients.. Your kidneys remove extra fluids and salt from your body. When they can no longer do this, the fluids and salt build up in your body. This build-up causes swelling, which you may notice in your: Legs, ankles, feet, hands, and face. You may notice that the swelling can occur in one or several areas of your body.

Rashes are also quite common among CKD patients. When kidneys cannot remove waste from your body, a rash can develop. One rash that occurs in people who have end-stage kidney disease causes small, dome-shaped, and extremely itchy bumps. As these bumps clear, new ones can form. Sometimes, the small bumps join together to form rough, raised patches. Blisters. Some people who have end-stage kidney disease develop blisters, which can form on their: Hands, face, and feet. The blisters will open, dry up, and crust over. As they clear, scars appear.

Calcium deposit under the skin can occur among the CKD patients. Your kidneys have several jobs. One is to balance certain minerals in your blood, such as sodium and phosphate. When the kidneys cannot maintain a healthy balance, levels can rise. Some people develop deposits of calcium in their skin, such as the patient in this picture. This patient also has half-and-half nails, which is another sign of kidney disease. Calcium deposits usually develop around a joint and are not painful. However, when they occur within a fingertip, they can cause a great deal of pain. If one of these deposits pushes up through the skin, you may see a chalky discharge.

Now that we have learnt of the various types of skin issues which A CKD patient may potentially face or fall prey to, we must also learn how to treat the issue. When a kidney disease affects the skin, a nephrologist may team up with a dermatologist. Some skin conditions that develop due to kidney disease can be difficult to control. For example, if a patient has extremely itchy skin, it may be impossible to sleep through the night. A Dermatologist can help a patient get some relief. This may involve using the right balance of moisturizers and medication that you apply to the skin. Some patients get relief with a treatment called UVB phototherapy. Several ointments have beneficial effects but It is always best to get a consultation from a Nephrologist and a Dermatologist if you feel that you may have any of the above mentioned issues. Before trying to treat it at home we should always value the medical opinion of our doctors.

Published by Dr.Pratim Sengupta

Dr. Pratim Sengupta thinks of himself as conscious, living, soulful being with an inner urge to break the inertia of life. He feels that life is nothing but a material expression of the Supreme Almighty Consciousness. His conscious existence empowered him to see, to hear, to talk, to interact, to feel, to dream, to ask questions, and to seek solutions to every problem. In the flow of life, as he grew up, he understood that knowledge of life is the only way to understand the scientific basis of conscious existence. Hence Dr. Sengupta felt the urge to study the science of life – i.e. Medicine. After he completed his higher secondary education from the Ramakrishna Mission Vidyamandira in Belurmath, he joined the MBBS (Bachelor of Medicine, Bachelor of Surgery) course at RG Kar Medical College, Kolkata. The professional packaging of knowledge in terms of a time-bound, goal-oriented syllabus frustrated him a bit, but nevertheless ignited the urge within him to study further. He thus went on to his post-graduation (MD) in Medicine from IPGMER and SSKM Hospital, Kolkata. During his MD training, he got a glimpse of the vastness of knowledge, and the quest to learn precisely the facts of life narrowed down his area of interest to the functioning of the kidneys and the specialisation of Nephrology – a discipline that is complex, yet relatively new and still evolving in terms of complete understanding of renal physiology and pathology. So, Dr. Sengupta decided to study and train for the DM (Doctorate of Medicine) degree in Nephrology. Right from the start of his career, Dr. Sengupta was passionate about Research. During the MD programme he worked on Cirrhotic Cardiomyopathy, Autonomic Neuropathy of Lupus, and Insulin resistance in Diabetics. All these research studies were published in national journals. During his postdoctoral study in Nephrology, he worked on Hemodialysis efficiency, and suggested an angular placement of the Dialyser in order to increase efficiency. This innovative concept was accepted for presentation at the World Congress of Nephrology, Milan, in 2009, and also published in Hemodialysis International. Dr. Sengupta also worked on Plasmapheresis – a blood filtering technique by which toxic and pathogenic immunoglobulins can be removed from the body. He studied the role of Prethymectomy Plasmapheresis in Myasthenia Gravis patients, and his findings were published in the journal Interactive Cardiovascular and Thoracic Surgery. The patient-empowered nutritional model for nutritional care of kidney patients is another interesting and innovative area in which Dr. Sengupta has worked for quite a long time. Dr.Pratim Sengupta won the Bharat Jyoti award for his excellency in the field of medicine. He is also the president of our non-governmental organization, The Kidney Care Society. His tireless contribution to provide quality living for his patients is worth mentioning. He introduced Mukti, blending ancient Indian yoga with modern medicine for well being of every patient. He has also introduced an unique online course "Art of Living with diabetes" which is a complete solution to diabetes management. He has authored many books, blogs, for the patients. Searching and researching for solutions to problems in the field of Nephrology remains the passion and dream of Dr. Pratim Sengupta, and he intends to persist on this journey as long as he is conscious. Meanwhile, even as he pursues his dreams, Dr. Sengupta diligently puts into practice all he has learned about Nephrology over the years, at the Belle Vue Clinic in Kolkata and ILS hospital,Dumdum where he is available for his patient

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