From the Guidelines
The treatment for uremic rash primarily focuses on addressing the underlying kidney dysfunction and managing symptoms, with renal transplantation being the only definite treatment 1.
Treatment Approach
The cornerstone of treatment is hemodialysis or peritoneal dialysis, as it removes uremic toxins that cause the rash. For symptom relief, the following approaches can be considered:
- Topical treatments: emollients like petroleum jelly or ceramide-containing moisturizers applied 2-3 times daily to hydrate the skin and reduce itching.
- Topical corticosteroids: such as hydrocortisone 1% cream can be applied to affected areas twice daily for up to two weeks to reduce inflammation.
- Oral antihistamines: like diphenhydramine (25-50mg every 6 hours) or hydroxyzine (25mg 3-4 times daily) may help in severe itching cases.
- Gabapentin: starting at 100mg three times daily, gradually increasing as needed, has shown effectiveness in treating uraemic pruritus 1.
- UVB phototherapy: has been shown to be effective in treating moderate-to-severe uraemic pruritus, with broadband UVB being the treatment of choice 1.
Additional Considerations
- Patients should avoid scratching, wear loose cotton clothing, maintain cool ambient temperatures, and use mild, fragrance-free soaps.
- Sedative antihistamines should be avoided long-term due to the risk of predisposing to dementia, except in palliative care situations 1.
- Cetirizine is not an effective antihistamine in uraemic pruritus 1.
- Renal transplantation is the only definite treatment for uremic rash, addressing the root cause of the condition 1.
From the Research
Treatment Options for Uremic Rash
- The treatment for uremic rash, also known as uremic pruritus, can be challenging, but several options are available 2, 3, 4, 5, 6.
- Optimal quality of dialysis is important, as well-dialyzed patients seem to experience less itching 2.
- Secondary hyperparathyroidism should be treated, as it can lead to mast cell proliferation and increased calcium phosphate deposition in the skin, aggravating the disease 2.
Pharmacological Treatments
- Gabapentin seems to be a favored treatment option due to its effectiveness and fewer side effects 2, 4.
- Ondansetron, a 5-HT(3)-receptor antagonist, has been studied as a potential treatment, but its effectiveness is unclear 5.
- Topical capsaicin therapy has been shown to be effective in reducing pruritus scores in patients on hemodialysis 6.
Non-Pharmacological Treatments
- Short wave UV treatment (UVB) is considered to be the treatment of choice for uremic pruritus 2.
- High-dose long wave UV (UVA) treatment may also be successful 2.
- Emollients are recommended for topical treatment, and capsaicin may be useful for localized itching 2.
Other Considerations
- Peripheral neuropathy may affect the perception of pruritus, and xerosis is frequently observed in patients with uremic pruritus 2.
- The effect of systemic antihistamines is at best marginal, and other treatments such as opioid receptor antagonists, cholestyramin, active charcoal, and thalidomide have been used, but their effectiveness is unclear 2, 4.