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INTRODUCTION

Dermatologic conditions are common in the renal transplant recipient and range from skin signs of systemic diseases that cause chronic kidney disease to findings that are unique to the uremic condition to cutaneous malignancies and infections associated with transplantation (Table 91-1). This chapter demonstrates a wide variety of these cutaneous changes; it also includes some of the adverse cutaneous drug reactions that may be seen in this group of patients.

TABLE 91-1

Dermatologic Conditions seen in Diseases Causing Chronic Kidney Disease

METABOLIC DISORDERS

Acanthosis Nigricans

The hyperpigmented, velvety hyperkeratosis of acanthosis nigricans is most commonly found around the neck, although any flexural area may be involved (Figures 91-1 and 91-2). More advanced cases are frequently studded with skin tags as well. When classic areas such as these are affected, acanthosis nigricans is a reliable marker for insulin resistance; however, skin findings may precede the development of diabetes mellitus by many years. There is no effective topical or systemic treatment for acanthosis nigricans; keratolytic agents and bleaching agents have no effect. However, if the patient can lose the excess weight before the development of diabetes mellitus, the skin changes will resolve. When atypical sites are affected—such the lips and tongue—an internal malignancy, most commonly gastric cancer, must be sought.

FIGURE 91-1

Acanthosis nigricans.

FIGURE 91-2

Acanthosis nigricans.

Necrobiosis Lipoidica

Seen in Figure 91-3 is a classic lesion of necrobiosis lipoidica (NLD) with a shiny, yellowish, atrophic epidermis allowing visibility of the dermal blood vessels deeper in the dermis. The shins are most commonly affected, although lesions may be found on the hands, forearms, trunk, and, less commonly, ...

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