This Scratch is NOT for the Lottery

Okay, let's imagine a conversation between Jenny and her dermatologist, Dr. Ramirez.

Setting: A dermatologist's clinic.

Characters:

• Jenny: A patient with kidney disease experiencing itchy skin and blemishes.
• Dr. Ramirez: A dermatologist.

Conversation:

Jenny: "Dr. Ramirez, thank you for seeing me. My kidneys haven't been working well lately, and ever since then, my skin has been driving me crazy! It's so itchy, and I've developed these awful blemishes. I'm so uncomfortable."

Dr. Ramirez: "I understand, Jenny. Kidney disease can often lead to skin problems.¹ Itching, or pruritus, is a common symptom due to the buildup of uremic toxins in your blood.² The blemishes could be related to that, or they might be something else entirely. Let's take a closer look."

(Dr. Ramirez examines Jenny's skin.)

Dr. Ramirez: "Yes, I see the itching and some dry, rough patches. The blemishes appear to be small, reddish bumps. It's possible that the itching is causing you to scratch, which is then leading to these bumps. We need to address the underlying cause of the itching first. Do you find the itching is worse at any particular time?"

Jenny: "It seems to be worse at night, and after I shower. I also have xerosis, my skin is very dry."

Dr. Ramirez: "That's common. Hot water can dry out the skin further, exacerbating the itching.³ And the buildup of urea can be more noticeable at night. Here's what we can do. First, we need to address the dryness. I'm going to prescribe a fragrance-free, hypoallergenic emollient to apply several times a day, especially after showering. Avoid hot water, and use lukewarm water instead. Pat your skin dry rather than rubbing it.

For the itching, we can consider a topical corticosteroid cream to reduce inflammation. We can also consider oral antihistamines, especially at night, as they can also help with sleep. For the uremic pruritus, there are also some medications that your nephrologist may prescribe, so it is important we work together with your Kidney doctor.

Regarding the blemishes, we'll monitor them. If they don't improve with the treatment for the itching, we might need to consider a biopsy to rule out other skin conditions."

Jenny: "That sounds good. I'm also worried about these white spots that have appeared on my skin. Is that related?"

Dr. Ramirez: "Those white spots could be hypopigmentation, which can sometimes occur with chronic skin irritation. We will watch those as well. Has your nephrologist mentioned any medication for the itching?"

Jenny: "They mentioned something called gabapentin, but I haven't started it yet."

Dr. Ramirez: "That's a good option. It can help with nerve-related itching. Please discuss this with your nephrologist, and let's coordinate our care. We need to address this from both a dermatological and nephrological perspective."

Jenny: "Thank you so much, Dr. Ramirez. I feel much better knowing there are solutions."

Dr. Ramirez: "You're welcome, Jenny. We'll schedule a follow-up appointment to monitor your progress. Please don't hesitate to call if you have any concerns in the meantime."