Bullous Disease of Dialysis Treatment & Management

  • Author: Maureen B Poh-Fitzpatrick, MD; Chief Editor: William D James, MD   more...
 
Updated: Apr 3, 2012
 

Medical Care

Any photosensitizing drug that the patient may be using should be identified and discontinued, if possible. N -acetylcysteine, a glutathione precursor used orally as a radiotherapy protector, was administered to 2 patients in a clinical trial; resolution of blistering and fragility followed after several weeks.[15] Another patient successfully treated with oral N -acetylcysteine was reported by Cooke and McKenna in 2007.[16]

Sunlight avoidance, use of long ultraviolet and visible light topical sunblock formulations, and protection of exposed skin from mechanical trauma may help reduce the severity of the lesions. Intermittent treatment of secondarily infected bullae or erosions with topical or systemic antibiotics may be required.

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Recommend avoidance of sunlight exposure and protection of hands from mechanical trauma.

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Contributor Information and Disclosures
Author

Maureen B Poh-Fitzpatrick, MD  Professor Emerita of Dermatology and Special Lecturer, Columbia University College of Physicians and Surgeons; Professor of Medicine (Dermatology), University of Tennessee Health Science Center College of Medicine

Maureen B Poh-Fitzpatrick, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and New York Academy of Medicine

Disclosure: Clinuvel Pharmaceuticals, Ltd. Honoraria Consulting

Specialty Editor Board

Shyam Verma  MBBS, DVD, FAAD, Clinical Associate Professor, Department of Dermatology, University of Virginia; Adjunct Associate Professor, Department of Dermatology, State University of New York at Stonybrook, Adjunct Associate Professor, Department of Dermatology, University of Pennsylvania

Shyam Verma is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

  1. Gilchrest B, Rowe JW, Mihm MC Jr. Bullous dermatosis of hemodialysis. Ann Intern Med. Oct 1975;83(4):480-3. [Medline].

  2. Keczkes K, Farr M. Bullous dermatosis of chronic renal failure. Br J Dermatol. Nov 1976;95(5):541-6. [Medline].

  3. Poh-Fitzpatrick MB, Bellet N, DeLeo VA, Grossman ME, Bickers DR. Porphyria cutanea tardia in two patients treated with hemodialysis for chronic renal failure. N Engl J Med. Aug 10 1978;299(6):292-4. [Medline].

  4. Brivet F, Drüeke T, Guillemette J, Zingraff J, Crosnier J. Porphyria cutanea tarda-like syndrome in hemodialyzed patients. Nephron. 1978;20(5):258-66. [Medline].

  5. Chazot C, Chazot I, Charra B, et al. Functional study of hands among patients dialysed for more than 10 years. Nephrol Dial Transplant. 1993;8(4):347-51. [Medline].

  6. Griffon-Euvrard S, Thivolet J, Laurent G, et al. [Detection of pseudo-porphyria cutanea tarda in 100 hemodialyzed patients (author's transl)]. Dermatologica. 1977;155(4):193-9. [Medline].

  7. Amblard P, Cordonnier D, Reymond JL, Beani JC, Elsener M, Guffon MP. [Pseudo-pseudo-porphyria tarda in hemodialyzed patients]. Ann Dermatol Venereol. 1981;108(12):1019-20. [Medline].

  8. Gibson GE, McGinnity E, McGrath P, et al. Cutaneous abnormalities and metabolic disturbance of porphyrins in patients on maintenance haemodialysis. Clin Exp Dermatol. May 1997;22(3):124-7. [Medline].

  9. Shelley WB, Shelley ED. Blisters of the fingertips: a variant of bullous dermatosis of hemodialysis. J Am Acad Dermatol. Nov 1989;21(5 Pt 2):1049-51. [Medline].

  10. Poh-Fitzpatrick MB, Sosin AE, Bemis J. Porphyrin levels in plasma and erythrocytes of chronic hemodialysis patients. J Am Acad Dermatol. Jul 1982;7(1):100-4. [Medline].

  11. Gafter U, Mamet R, Korzets A, Malachi T, Schoenfeld N. Bullous dermatosis of end-stage renal disease: a possible association between abnormal porphyrin metabolism and aluminium. Nephrol Dial Transplant. Sep 1996;11(9):1787-91. [Medline].

  12. Glynne P, Deacon A, Goldsmith D, Pusey C, Clutterbuck E. Bullous dermatoses in end-stage renal failure: porphyria or pseudoporphyria?. Am J Kidney Dis. Jul 1999;34(1):155-60. [Medline].

  13. Perrot H, Germain D, Euvrard S, Thivolet J. Porphyria cutanea tarda-like dermatosis by hemodialysis. Ultrastructural study of exposed skin. Arch Dermatol Res. Aug 22 1977;259(2):177-85. [Medline].

  14. Thivolet J, Euvrard S, Perrot H, Moskovtchenko JF, Claudy A, Ortonne JP. [Pseudo-late onset cutaneous parphyria in haemodialysis patients. Clinical and histological features. 9 cases (author's transl)]. Ann Dermatol Venereol. Jan 1977;104(1):12-7. [Medline].

  15. Vadoud-Seyedi J, de Dobbeleer G, Simonart T. Treatment of haemodialysis-associated pseudoporphyria with N-acetylcysteine: report of two cases. Br J Dermatol. Mar 2000;142(3):580-1. [Medline].

  16. Cooke NS, McKenna K. A case of haemodialysis-associated pseudoporphyria successfully treated with oral N-acetylcysteine. Clin Exp Dermatol. Jan 2007;32(1):64-6. [Medline].

 
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