Cutaneous manifestations of chronic renal failure in children of color

One hundred percent of adult patients with chronic renal failure (CRF) deve lop cutaneous findings as a result of uremia or due to therapeutic interven tions. 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 stu dy to assess the prevalence of renal failure-related skin disease in childr en of color, including African American and Hispanic patients. Thirty child ren 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, dru g-related, or infectious disease types. The incidence of skin disease was 1 00%. Xerosis was the single most common finding, often accompanied by pruri tus. Cushinoid features were common despite the addition of steroid-sparing agents. Cyclosporin A-treated African American children had a high inciden ce of gingival hypertrophy (72%) and an even higher incidence of hypertrich osis (100%). Acral warts and nevi were common findings, the latter correlat ing with the length of immunosuppression. There is a high incidence of cosm etically disfiguring side effects (Cushinoid facies, hypertrichosis, and gi ngival hypertrophy) in children within all treatment categories, primarily related to drug treatment. Further study is required to determine the long- term sequelae, including psychological disturbances, of cutaneous disease i n children of color with CRF.