Cutaneous manifestations of chronic renal failure in children of color

One hundred percent of adult patients with chronic renal failure (CRF) develop cutaneous findings as a result of uremia or due to therapeutic interventions. To date, pediatric incidence studies have been limited to Caucasian children. However, recent reports have indicated that more African American patients progress to end-stage renal disease (ESRD). This is the first study to assess the prevalence of renal failure-related skin disease in children of color, including African American and Hispanic patients. Thirty children were evaluated by history and physical examination, with assignment to one of three treatment categories: transplanted (n = 10), dialyzed (n = 16), or medically managed (n = 4). Skin findings were divided into uremic, drug-related, or infectious disease types. The incidence of skin disease was 100%. Xerosis was the single most common finding, often accompanied by pruritus. Cushinoid features were common despite the addition of steroid-sparing agents. Cyclosporin A-treated African American children had a high incidence of gingival hypertrophy (72%) and an even higher incidence of hypertrichosis (100%). Acral warts and nevi were common findings, the latter correlating with the length of immunosuppression. There is a high incidence of cosmetically disfiguring side effects (Cushinoid facies, hypertrichosis, and gingival hypertrophy) in children within ali treatment categories, primarily related to drug treatment. Further study is required to determine the long-term sequelae, including psychological disturbances, of cutaneous disease in children of color with CRF.