Bullous Disease of Dialysis Medication

Updated: Dec 26, 2019
  • Author: Amira M Elbendary, MD, MBBCh, MSc; Chief Editor: William D James, MD  more...
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Medication Summary

Oral administration of the glutathione precursor N-acetylcysteine (600-1200 mg/day) was followed by resolution of blistering and fragility within 3 weeks to 2 months in several cases of bullous disease of dialysis. [18, 19, 20, 21, 22, 23] Another glutathione precursor, oral glutamine (at a dose of 10 g/day), plus sunlight avoidance, was similarly effective in one case. [24] Two vitamin D‒deficient patients had resolution of bullae within 30 days with ultraviolet exposure avoidance and vitamin D supplementation. [25] One hemodialyzed patient with photodistributed bullae said to represent "pseudoporphyria", but who also had excess urinary uroporphyrin, hypertrichosis, dyspigmentation, and sclerodermoid changes consistent with a true porphyria, had incomplete resolution of bullae after 3 months of cessation of oral contraceptive pills, sunlight avoidance, and N-acetylcysteine at 800 mg/day, but complete resolution after changing treatment to chloroquine 200 mg/wk for a month. [26]


Enzymes, Mucolytic

Class Summary

Agents that scavenge oxygen-derived free radicals and improve endothelium-dependent vasodilation may be of benefit.

N-acetylcysteine (Acetadote)

N -acetylcysteine is a glutathione precursor. It may provide effective photoprotection by increasing the availability of glutathione, a potent antioxidant.