Day 2 of the SDPA Annual Summer Conference started with an enlightening lecture on nephrocutaneous disease presented by Dr. Jennie Clarke. For reasons that are not completely understood, xerosis and pruritis are the two most common presentations of patients with end stage renal disease. Unfortunately, dialysis does not help improve these conditions. Treatment of these conditions can be a challenge and can involve nutrition, nonsedating antihistamines, gabapentin, light therapy, topical medications and ruling out other causes. Next, Dr, Clarke discussed pigmentary changes including pallor and yellow discoloration of the patient with kidney disease and explained the presentation and pathophysiology of “Lindsay Nails” in renal failure patients.
Calciphylaxis, an uncommon presentation with a high mortality rate, is a poor prognostic sign in the patient with kidney disease. It can be sudden in onset and rapidly progress. Dr. Clarke explained the most common presentation, best way to biopsy this condition, and the multidisciplinary approach of treatment to this patient. Further, acquired perforating disorders and porphyria or pseudoporphyria were discussed.
Dr. Clarke detailed presentations of vasculitis and explained the proper type of biopsies for a palpable purpura. She touched upon polyarteritis nodosa, lupus, and typical and less common cutaneous findings of patients with systemic lupus. Dr. Clarke stressed that in patients with an established cutaneous lupus diagnosis, it is important to screen for systemic disease yearly.
Dr. Clarke also discussed the numerous findings of patients with systemic sclerosis including “salt and pepper” hypopigmentation on the upper back and chest. “Dermatologists may be the first to diagnose sarcoidosis” in a patient according to Dr. Clarke. Clinical findings must be supported by a biopsy for the diagnosis of sarcoidosis.
Lastly, Dr. Clarke illuminated the importance of monitoring for renal toxicities in dermatologic therapies of patients.