Skin barrier structure and function and their relationship to pruritus in end-stage renal disease

Gil Yosipovitch; Maria I Duque; Tejesh S Patel; Yozo Ishiuji; Daniela A Guzman-Sanchez; Aerlyn G Dawn; Barry I Freedman; Yiong H Chan; Debra Crumrine; Peter M Elias

doi:10.1093/ndt/gfm375

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Skin barrier structure and function and their relationship to pruritus in end-stage renal disease

Journal article

Open access

Peer reviewed

Skin barrier structure and function and their relationship to pruritus in end-stage renal disease

Gil Yosipovitch, Maria I Duque, Tejesh S Patel, Yozo Ishiuji, Daniela A Guzman-Sanchez, Aerlyn G Dawn, Barry I Freedman, Yiong H Chan, Debra Crumrine and Peter M Elias

Nephrology, dialysis, transplantation, Vol.22(11), pp.3268-3272

2007-11

DOI: https://doi.org/10.1093/ndt/gfm375

PMID: 17595180

Abstract

chronic renal disease

electron microscopy

glycerol

permeability recovery

stratum corneum integrity

uraemic pruritus

Background. The relationship between dry skin and uraemic pruritus remains controversial. In addition, there is a lack of published data describing the structure and function of the stratum corneum (SC) in end-stage renal disease (ESRD). The purpose of the present study was to assess the function and structure of the skin barrier in patients with ESRD and to correlate any abnormalities with uraemic pruritus. Methods. Thirty-eight subjects participated in the study; 20 with ESRD and 18 healthy controls. Subjects underwent evaluation of SC integrity and permeability barrier recovery, SC surface pH, pruritus and dry skin. The content of glycerol, an important endogenous humectant, was assessed in D-squame tape strips from seven patients with ESRD. Skin biopsies from six of these patients were examined by electron microscopy using ruthenium tetroxide (Ru04)-post-fixation. Results. Although SC integrity was impaired in ESRD patients (P = 0.001), there were no significant differences in permeability barrier recovery rates between ESRD subjects and controls. However, there was a high significant negative correlation between SC glycerol content and dry skin in the arms of ESRD subjects (r = −0.866, P = 0.01). Yet, there was no consistent correlation between pruritus and either dry skin, SC integrity, glycerol content or surface pH. Electron microscopy revealed no significant ultra-structural abnormalities, with particular reference to the lipid bi-layer. Conclusions. SC integrity, but not permeability barrier recovery, is impaired in dialysis patients. Although dry skin in ESRD is associated with reduced SC glycerol levels, the ultra-structure appears to be unaffected.

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.65 Allergy; 1.65.1091 Atopic Dermatitis
Web Of Science research areas: Transplantation; Urology & Nephrology
ESI research areas: Clinical Medicine

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Title: Skin barrier structure and function and their relationship to pruritus in end-stage renal disease
Creators: Gil Yosipovitch - Department of Dermatology, Department of Neurobiology and Anatomy, Department of Regenerative Medicine and Section on Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Department of Dermatology, University of California and VA Medical Center, Dermatology Section, San Francisco, USA
Maria I Duque - Department of Dermatology, Department of Neurobiology and Anatomy, Department of Regenerative Medicine and Section on Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Department of Dermatology, University of California and VA Medical Center, Dermatology Section, San Francisco, USA
Tejesh S Patel - Department of Dermatology, Department of Neurobiology and Anatomy, Department of Regenerative Medicine and Section on Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Department of Dermatology, University of California and VA Medical Center, Dermatology Section, San Francisco, USA
Yozo Ishiuji - Department of Dermatology, Department of Neurobiology and Anatomy, Department of Regenerative Medicine and Section on Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Department of Dermatology, University of California and VA Medical Center, Dermatology Section, San Francisco, USA
Daniela A Guzman-Sanchez - Department of Dermatology, Department of Neurobiology and Anatomy, Department of Regenerative Medicine and Section on Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Department of Dermatology, University of California and VA Medical Center, Dermatology Section, San Francisco, USA
Aerlyn G Dawn - Department of Dermatology, Department of Neurobiology and Anatomy, Department of Regenerative Medicine and Section on Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Department of Dermatology, University of California and VA Medical Center, Dermatology Section, San Francisco, USA
Barry I Freedman - Department of Dermatology, Department of Neurobiology and Anatomy, Department of Regenerative Medicine and Section on Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Department of Dermatology, University of California and VA Medical Center, Dermatology Section, San Francisco, USA
Yiong H Chan - Department of Dermatology, Department of Neurobiology and Anatomy, Department of Regenerative Medicine and Section on Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Department of Dermatology, University of California and VA Medical Center, Dermatology Section, San Francisco, USA
Debra Crumrine - Department of Dermatology, Department of Neurobiology and Anatomy, Department of Regenerative Medicine and Section on Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Department of Dermatology, University of California and VA Medical Center, Dermatology Section, San Francisco, USA
Peter M Elias - Department of Dermatology, Department of Neurobiology and Anatomy, Department of Regenerative Medicine and Section on Nephrology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Department of Dermatology, University of California and VA Medical Center, Dermatology Section, San Francisco, USA
Publication Details: Nephrology, dialysis, transplantation, Vol.22(11), pp.3268-3272
Publisher: Oxford University Press
Academic Unit: Miller School of Medicine; UMMG Dept of Dermatology & Cutaneous Surgery
Language: English
Resource Type: Journal article
PMID: 17595180
Record Identifier: 991031613891002976