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Organ failure rash: 11 ways it can affect your skin

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11 ways it can affect your skin

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Can it cause itchy skin and rashes?

Kidney disease may not cause any symptoms or signs in its early stages. As it progresses, it can cause symptoms such as itchy skin, or pruritus, and a rash.

More than 37 million adults in the United States live with chronic kidney disease, but only about 10% know they have it. This is because the early stages of kidney disease do not typically cause symptoms.

As the disease progresses, it can cause general symptoms, including fatigue, frequent urination, and itchy skin. Because many of the symptoms, including itchy skin, are not specific to kidney disease, a person may only find out they have it through testing.

This article reviews itchy skin as a symptom of kidney disease, as well as its causes, symptoms, and more.

Kidney disease can cause dry, irritated, and itchy skin, or “pruritus.” Healthcare professionals refer to itchy skin that results from chronic kidney disease as chronic kidney disease-associated pruritus (CKD-aP).

People with CKD-aP can also experience a rash, dry skin, or skin lesions due to scratching.

Some experts may refer to this condition as uremic pruritus because of the buildup of toxic materials and chemicals that the kidneys typically filter out of a person’s blood. The kidneys cannot filter blood as usual if kidney disease has damaged them.

Like other symptoms, itchy skin and rashes may not appear in the early stages of kidney disease. Instead, they may appear when the minerals in the blood become unbalanced due to the kidney’s diminished filtering capabilities.

According to a 2019 review, up to 84% of people with end stage chronic kidney disease develop pruritus. The authors state that recent advancements in dialysis treatments have helped bring the percentage down, but it is still around 40%.

Learn more about end stage kidney disease.

The exact cause of CKD-aP is not clear, but theories suggest that it may involve any of the following factors:

  • immune system response
  • a lack of balance in signals sent to opioid receptors in nerve cells
  • hyperparathyroidism — high parathyroid hormone (PTH) levels in the blood
  • the release of histamine and other chemicals from cells, which can cause itching
  • insufficient dialysis that does not properly remove toxins and wastes
  • nerve damage
  • high aluminum or magnesium levels in the blood
  • high combined levels of calcium and phosphorus in the blood
  • shrinkage of sweat glands, which can lead to dry skin

Pruritis symptoms can last for months to years and affect different areas of the body. For some people, this condition may lead to a reduced quality of life.

Itchy skin symptoms

Up to half of people experience itchiness on their entire body. Alternatively, it may affect only a certain part of the body, such as the face, back, or arm.

Itchy skin due to kidney disease often:

  • worsens at night
  • improves with activity
  • worsens due to heat, stress, or other factors
  • fluctuates during hemodialysis sessions
  • improves with hot or cold showers or in cool temperatures

The extremely itchy skin can also cause a person to experience:

  • reduced self-esteem
  • changes in mood
  • depression
  • changes in personal relationships
  • worsening sleep
  • infections due to continual scratching, which may lead to hospitalization or death

Rash symptoms

People with chronic kidney disease may not experience any skin symptoms, or they may have a rash, dry patches, and blisters. They may also develop skin lesions due to scratching itchy skin.

According to the American Academy of Dermatology (AAD), people with chronic kidney disease may have:

  • small, dome-shaped, very itchy bumps
  • small bumps that have joined to form raised rough patches
  • blisters on the hands, face, and feet that may crust over
  • extremely dry skin that may feel tight and look scaly or cracked
  • skin lesions, scratch marks, or thickened, dry skin from excessive scratching

Anyone can develop skin lesions as a result of scratching their skin repeatedly, so appropriate treatment is helpful for preventing further damage to the skin.

People often do not receive a diagnosis for itchy skin in any stage of kidney disease. This may be partly due to differences in symptoms from person to person.

A healthcare professional may try to confirm the diagnosis with a skin exam or a review of dialysis numbers or by trying different topical treatments.

Unless another underlying cause may be present, healthcare professionals may consider any instances of itchy skin in a person with kidney disease to be pruritis.

If a person is experiencing even infrequent itchiness, it is important that they report their symptoms to a healthcare professional so they can receive a diagnosis and begin treatment.

Learn more about potential signs of kidney damage.

Treatment may include both systemic medications, which work throughout the body, and topical products, which a person can apply directly to the affected area.

People on dialysis will likely benefit from treatments that help with high PTH, phosphorus, and magnesium levels in their blood.

This may involve:

  • certain medications
  • changes in dialysis prescription
  • increases in dialysis treatment times
  • a change in the type of dialysis filter

Healthcare professionals will typically start treatment with topical creams and ointments to help relieve itching. People may use emollients that moisten and soften the skin and analgesics that alleviate itching and reduce pain.

If a person does not respond well to topical treatments, a healthcare professional may recommend:

  • antihistamines
  • medication for nerve pain, such as gabapentin or pregabalin
  • ultraviolet B (UVB) phototherapy
  • difelikefalin — a drug that improves the imbalance of nerve signals that leads to itching — for people on dialysis

Experimental treatments include the use of omega-3 and omega-6 fatty acids. However, more research is needed on their effectiveness for itchy skin in chronic kidney disease.

Here are some answers to frequently asked questions about kidney disease.

At what stage of kidney disease does itching occur?

A person’s skin may itch at any stage of kidney disease, but itching is most common in advanced stages or during kidney failure.

What are the three early warning signs of kidney disease?

Early warning signs can differ from person to person but may include:

  • swelling (edema)
  • increased urine output or frequency
  • fatigue

Symptoms often do not show until the later stages of kidney disease. If a person experiences one or more of these symptoms, they should consult a healthcare professional as soon as possible.

Kidney disease can lead to itchy skin or a rash. This can occur at any stage of the disease but is most common in more advanced stages.

When it occurs, it may appear all over the body or in only certain areas. Some people will not see any signs of skin rash, such as raised bumps, spots, or blisters, while others may. Chronic and frequent scratching can lead to lesions and other sores on the skin.

Treatment typically involves a combination of topical creams and systemic medications.

causes, pathogen, symptoms, signs, complications, diagnosis, treatment, prevention

Causes

Classification

Symptoms

Complications

Diagnosis

Treatment

Profile aktika

Scarlet fever is an acute infectious disease caused by group A pyogenic streptococcus. It can proceed both in an erased, asymptomatic form, and rapidly, with the development of severe purulent-septic complications.

Characteristic manifestations of the disease are pronounced inflammation in the oropharynx, the rise in overall body temperature to high numbers, redness and enlargement of the papillae of the tongue, the appearance of a confluent punctate rash on the body, followed by peeling of the skin. Treatment is based on the use of antibiotics, usually penicillins.

Scarlet fever is more common in children aged 2 to 10 years. However, in adults, it is more severe, the risk of complications is higher. The incidence increases in the autumn-winter period.

Causes of scarlet fever

The causative agent of scarlet fever is group A b-hemolytic streptococcus. The round-shaped bacterium tends to unite in colonies that form chains of different lengths. The microorganism is resistant to external influences and is widely distributed in the environment.

The cause of scarlet fever may be close contact with a sick person, poor hygiene or food preparation. Infection occurs when the pathogen is swallowed, it enters the mucous membranes of the eyes or nasopharynx, less often the genitals. Infection can also occur through breaks in the skin. Symptoms of the disease develop only in the absence of type-specific immunity to b-hemolytic streptococcus group A.

Scarlet fever classification

According to the nature and intensity of the manifestations of the disease, its typical and atypical forms are distinguished. The latter option includes scarlet fever with an erased and hypertoxic course, as well as extrapharyngeal infection in case of infection through skin lesions in wounds and burns.

There are also mild, moderate and severe (toxic, septic, toxic-septic) degrees of scarlet fever.

The disease proceeds in several stages:

  1. The incubation period of scarlet fever. It represents the time interval from the moment of infection to the appearance of the first symptoms. Its duration is from one to seven days.
  2. Initial stage. Characterized by deterioration of health, fever, redness of the mucous membranes in the oropharynx, enlargement of the cervical lymph nodes.
  3. Eruption period. The first signs of scarlet fever are accompanied by a rash on the skin, which persists for 7-10 days.
  4. The period of recovery or development of complications. With a favorable course from the second week from the onset of the disease, the intensity of symptoms gradually decreases, the skin in the places of rashes peels off, the temperature returns to normal.

Symptoms of scarlet fever

In a typical course, the disease begins with a rise in temperature to 38–39 degrees, accompanied by chills and symptoms of intoxication of the body, such as weakness, headache, muscle aches, nausea, and vomiting. Characteristic symptoms of scarlet fever are also severe sore throat, aggravated by swallowing, enlargement and sensitivity of the cervical and submandibular lymph nodes.

The palatine arches and tonsils are bright red on examination. The latter are enlarged in size and may be covered with a fibrinous-purulent coating. Specific language changes in scarlet fever. In the first days of the disease, it is densely covered with a white coating. On the 4-5th day, it is cleared, but acquires a scarlet color and a characteristic granularity, the papillae increase. Due to its characteristic appearance, it is called “raspberry”.

Spotted spotted rash with scarlet fever appears simultaneously, within the first four days after the end of the incubation period. In larger quantities, it is localized on the forehead and cheeks, leaving the nasolabial triangle free, as well as on the neck, upper third of the chest and back. In the folds of the limbs, inguinal and axillary areas, the rash becomes confluent, forming erythema. In the process of recovery, the spots turn pale, leaving areas of skin peeling behind for some time.

In the case of the extrapharyngeal form of the disease, there are no symptoms of lesions of the oropharynx. The rash is located mainly around the wound or burn surface. A purulent-necrotic focus is also formed there.

In adults, scarlet fever often occurs atypically, in a hypertoxic severe form, or, on the contrary, with erased symptoms. During pregnancy, the infection can cause miscarriage or premature birth.

Complications of scarlet fever

The most common purulent-inflammatory complications of scarlet fever include lymphadenitis, otitis, damage to the paranasal sinuses and sinuses. With the addition of infectious-allergic and autoimmune mechanisms in the later stages of the disease, damage to internal organs and joints is possible:

  • carditis;
  • chorea;
  • arthritis;
  • glomerulonephritis.

The most dangerous complication is infectious-toxic shock.

Scarlet fever diagnostics

At the first sign of illness, you should contact your pediatrician, family doctor or general practitioner. Diagnosis of scarlet fever includes the collection of complaints, external examination of the patient’s oropharynx and skin, laboratory and instrumental research methods. If infection with pyogenic group A streptococcus is suspected, the following tests are performed:

  • clinical blood test;
  • blood biochemistry, determination of the concentration of C-reactive protein, liver enzymes;
  • general urine analysis with sediment microscopy;
  • streptatest;
  • smear from the oropharynx to identify the pathogen;
  • bacterial culture for group A b-hemolytic streptococcus and determination of its sensitivity to antibiotics;
  • blood test for antistreptolysin-O.

To identify complications according to indications, ultrasound of the abdominal organs, electrocardiographic examination and echocardiography are performed.

Treatment of scarlet fever

Scarlet fever is treated by an infectious disease specialist. With a mild course of the disease, it can be done on an outpatient basis. Moderate and severe cases require hospitalization of the patient.

The patient is recommended bed rest, sparing diet. To combat the pathogen in scarlet fever, antibiotics from the group of penicillins or cephalosporins are used. Additionally, antiseptic, non-steroidal anti-inflammatory and anti-allergic drugs are used. In severe cases, the patient is hospitalized and prescribed droppers with special solutions.

Prevention of scarlet fever

To prevent the pathogen from entering the body, one should remember how scarlet fever is transmitted. Based on the ways in which the infection spreads, the measures to prevent the disease will be as follows:

  • frequent hand washing with soap;
  • observance of sanitary rules for the preparation and storage of food;
  • treatment with an antiseptic solution of any wounds and abrasions;
  • if possible, limiting stay in crowded places, especially in the autumn-winter season;
  • seeking medical help at the first symptoms of the disease, followed by isolation of the patient;
  • refusal to attend kindergarten by children who had contact with a sick person.

Methods for the specific prevention of scarlet fever, such as vaccinations and vaccines against the pathogen, have not been developed. Immunity is developed only in those who have been ill to a specific strain of the pathogen. Repeated cases of the disease are rare and are associated, as a rule, with a pronounced decrease in the body’s defenses.

The author of the article:

Ivanova Natalya Vladimirovna

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