Dermatosis perforante adquirida e Índice de Calidad de Vida en Dermatología en pacientes en hemodiálisis / Acquired perforating Dermatology Life Quality Index in dermatology in patients receiving hemodialysis

Introducción: La dermatosis perforante adquirida (DPA) es un trastorno frecuente en pacientes en hemodiálisis, y el efecto en la calidad de vida está poco descrito. Investigamos la prevalencia de DPA en pacientes en hemodiálisis, medimos y comparamos la calidad de vida asociada a DPA. Métodos: Desarrollamos un estudio prospectivo, observacional y descriptivo. Invitamos a pacientes mayores de 18 años en hemodiálisis. Se obtuvieron datos de su expediente electrónico, y se realizó exploración dermatológica. Se aplicó el Índice de Calidad de Vida en Dermatología (DLQI). Se hizo un análisis descriptivo de las variables demográficas, de las características clínicas y de los hallazgos de dermatoscopia, así como la comparación de los puntajes del DLQI. Resultados: La muestra fue de 46 pacientes, con una prevalencia de DPA del 11%. Los pacientes con DPA eran más delgados y jóvenes en comparación con los pacientes sin DPA. El tiempo en hemodiálisis fue mayor en los pacientes con DPA en comparación a los pacientes sin DPA, con una mediana de 90 versus 32 meses (p=0,015). La afección en calidad de vida fue mayor en los pacientes con DPA en comparación a los pacientes sin DPA, con un algún efecto en todos los pacientes con DPA y un 33% en los pacientes sin DPA (p=0,001). Los pacientes con DPA tuvieron con más frecuencia prurito en comparación con los pacientes sin DPA (p=0,007). Conclusiones: La edad, el tiempo en hemodiálisis y el índice de masa corporal se asocian con la presencia de DPA. Los pacientes con DPA tuvieron una prevalencia más alta de prurito y mayor afección en la calidad de vida en dermatología en comparación con los pacientes sin DPA. (AU)

Introduction: Acquired perforating dermatosis (APD) is a frequent disorder in hemodialysis patients and the effect on the quality of life is poorly described. We investigated the prevalence of APD in hemodialysis patients, measured and compared APD-associated quality of life. Methods: We developed a prospective, observational, and descriptive study. We invited patients over the age of 18 in hemodialysis. Data was obtained from their electronic file and a dermatological examination was performed. The Dermatology Life Quality Index (DLQI) was applied. Descriptive analysis of demographic variables, clinical features, and dermoscopy findings, as well as comparison of DLQI scores, was made. Results: The sample consisted of 46 patients, with a prevalence of APD of 11%. Patients with APD were leaner and younger compared to patients without APD. The time on hemodialysis was longer in patients with APD compared to those without APD, with a median of 90 versus 32 months (P=.015). The impact on quality of life was greater in patients with APD compared to those without APD, with some effect in all patients with APD and 33% in patients without APD (P=.001). Patients with APD had more frequent pruritus compared to those without APD (P=.007). Conclusions: Age, time on hemodialysis and BMI are associated with the presence of APD. Patients with APD had a higher prevalence of pruritus and a greater impact on quality of life in dermatology compared to patients without APD. (AU)

Acquired Perforating Dermatosis and Dermatology Life Quality Index in Patients Receiving hemodialysis.

INTRODUCTION: Acquired perforating dermatosis (APD) is a frequent disorder in hemodialysis patients and the effect on the quality of life is poorly described. We investigated the prevalence of APD in hemodialysis patients, measured and compared APD-associated quality of life. METHODS: We developed a prospective, observational, and descriptive study. We invited patients over the age of 18 in hemodialysis. Data was obtained from their electronic file and a dermatological examination was performed. The Dermatology Life Quality Index (DLQI) was applied. Descriptive analysis of demographic variables, clinical features, and dermoscopy findings, as well as comparison of DLQI scores, was made. RESULTS: The sample consisted of 46 patients, with a prevalence of APD of 11%. Patients with APD were leaner and younger compared to patients without APD. The time on hemodialysis was longer in patients with APD compared to those without APD, with a median of 90 versus 32 months (p = 0.015). The impact on quality of life was greater in patients with APD compared to those without APD, with some effect in all patients with APD and 33% in patients without APD (p = 0.001). Patients with APD had more frequent pruritus compared to those without APD (p = 0.007). CONCLUSIONS: Age, time on hemodialysis and BMI are associated with the presence of APD. Patients with APD had a higher prevalence of pruritus and a greater impact on quality of life in dermatology compared to patients without APD.

Dermatosis perforante adquirida. Reporte de 2 casos en pacientes con diabetes mellitus y enfermedad renal crónica en hemodiálisis / Acquired perforating dermatosis. Case report of two patients with diabetes mellitus and chronic renal disease undergoing hemodialysis

Las dermatosis perforantes (DP), constituyen un grupo heterogéneo de enfermedades hereditarias o adquiridas caracterizadas por la migración transepidérmica de componentes de la matriz extracelular de la dermis (colágeno, tejido elástico o tejido conectivo necrótico) luego de un proceso inflamatorio y/o degenerativo. La etiopatogenia de la dermatosis perforante adquirida (DPA) es desconocida. Sin embargo presenta una fuerte asociación con traumatismos leves, insuficiencia renal crónica (IRC) y diabetes mellitus, y con menor frecuencia, con endocrinopatías, enfermedades infectocontagiosas y neoplasias, entre otras. En pacientes que realizan hemodiálisis, las DPA pueden observarse en el 10 al 12% de los casos. El prurito es el síntoma cardinal de esta entidad. En algunos pacientes su intensidad puede incluso llegar a ser discapacitante, y las excoriaciones por rascado secundarias al mismo llegan a generar extensas lesiones con alteración de la función de la piel como barrera cutánea. Se presentan dos casos clínicos, ambos con antecedentes de diabetes mellitus e IRC en etapa terminal, con requerimiento de terapia de reemplazo renal (TRR), en hemodiálisis trisemanal. Consultan por una dermatosis pruriginosa generalizada de meses de evolución. Al examen físico presentan lesiones sobreelevadas, hiperpigmentadas, con centro umbilicado rodeadas por un halo eritematoso, localizadas en rostro, tronco y miembros. El examen histopatológico revela una DPA

Perforating dermatoses (PD) represent a heterogeneous group of inherited or acquired diseases characterized by transepidermal migration of dermis extracellular matrix components (collagen, elastic tissue or necrotic connective tissue) following an inflammatory and/or degenerative process. The etiopathogenesis of acquired perforating dermatosis (APD) is unknown. However, it is strongly associated with minor trauma, chronic renal failure and diabetes mellitus and, less frequently, with endocrinological diseases, infectious diseases, neoplastic growth, among others. Acquired perforating dermatoses are diagnosed in 10-12 % of patients undergoing hemodialysis. Itching constitutes the main symptom of this disorder. In some cases, it may be incapacitating and secondary excoriation due to scratching may cause extensive lesions altering the skin barrier function. We report the cases of two patients undergoing hemodialysis three times a week, both with a history of diabetes mellitus and end-stage chronic renal failure requiring renal replacement therapy (RRT). These patients presented with generalized itching dermatosis which had been going on for months. Upon physical examination, raised, hyperpigmented lesions with an umbilicated center and surrounded by an erythematous halo were observed on the face, trunk and limbs. Histopathological examination revealed APD.e

Acquired perforating dermatosis: a report of 8 cases.

Acquired perforating dermatosis (APD) is an uncommon disease characterized by lesions exhibiting transepidermal elimination of collagen or elastic fibers. APD affects adults and is associated with systemic diseases, mainly diabetes mellitus and renal failure. We present 8 cases of APD. Seven patients had concomitant diabetes mellitus with or without chronic renal failure, and 1 had alcoholic cirrhosis. In the patients with chronic renal failure, the onset of APD coincided with transient worsening of renal function. The mean increase in creatinine concentrations above baseline was 1.14mg/dL. Acute deterioration of renal function may be involved in APD. Further studies are needed to investigate this association.