Table 1.

Overview of non-specific skin changes in chronic kidney disease

Non-specific skin changes	Etiopathogenesis	Clinical features	Treatment
Xerosis	Exact mechanism is not clear; proposed mechanisms are:  a) dehydration of the stratum corneum  b) abnormal eccrine gland function  c) reduced sebum and sweat production due to gland atrophy.	Skin appears dry, rough, or shiny. Xerotic skin may not be pruritic. Excoriations are associated with pruritus. Extensor surfaces of the lower extremities are most prominently involved.	Mainstay is hydration of the skin with moisturizing creams associated with 5-10% urea.
Acquired ichthyosis	Unknown	It is related to xerosis but is more than just dry skin, because the skin develops patterned scaly appearance.	Hydration of the skin.
Pigmentary alterations	a) Anemia of chronic disease b) Urochrome and carotenoid deposition in CKD c) Increased melanin production as a result of elevated levels of β-melanocyte-stimulating hormone.	Pallor Yellowish discoloration (most common) Hyperpigmentation	Erythropoiesis stimulating agents and iron. No treatment Sunscreen and photoprotection
Purpura	Qualitative platelet dysfunction due to uremia.	Purpura/ecchymoses can be spontaneous or in response to minor traumas.	Dialysis, desmopressin i.v estrogen
Nail changes: Lindsay (half-and-half) nail	Seen in approximately in 40% of uremic patients; likely due to melanin deposition in the nail bed and plate.	The distal portion is a pink-red, or brown horizontal band that occupies nearly half of the total nail length. Underlying nail bed changes give the proximal portion a dullwhite, ground-glass appearance. Other nail changes include absent, splinter hemorrhages, koilonychia, onycholysis, Mees’ lines, Muehrcke’s lines, Beau’s lines	No treatment. The nails may revert to normal following renal transplantation.
Mucosal changes	Nutritional deficiencies, candidiasis, poor oral hygiene, smoking, consumption of alcohol or hot/ spicy foods, dehydration, and mouth breathing remain the overall pathogenic triggers	Coated tongue, macroglossia with teeth markings, xerostomia, cheilitis and gingivitis	Maintenance of oral hygiene and eliminating potential triggers
Hair changes	Reduced sebum production and parathormone levels, anemia, stress of chronic disease/dialysis, or neglect	Sparse scalp and body hair, diffuse alopecia, lustreless hair	No specific therapy. Ensuring proper self-care is recommended
Cutaneous features due to hormonal changes	Elevated prolactin levels	Gynaecomastia in men and hirsutism and acne in women. Acanthosis nigricans resulting from insulin resistance may also be encountered.	Endocrinological consultation