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February 1993

Hyperpigmentation, Bullae, and Keratotic Papules in a Renal Dialysis Patient

Author Affiliations

University of California, Irvine Medical Center, Orange

Arch Dermatol. 1993;129(2):231-232. doi:10.1001/archderm.1993.01680230117017

REPORT OF A CASE  A 27-year-old woman with a history of dialysis-dependent renal failure presented to the dermatology clinic with a 6-week history of diffuse hyperpigmentation. She had previously been fair skinned and denied excess sun exposure. She also noted increased skin fragility on her hands and feet and the development of blisters on her hands without trauma. She also complained of a pruritic eruption on her buttocks and thighs.Physical examination revealed diffuse hyperpigmentation, including non-sun-exposed areas (Fig 1). Mucous membranes were spared. There was mild hypertrichosis over the forehead and temples and several tense bullae on the dorsa of her hands. The skin surrounding the bullae was not inflamed. On the buttocks and thighs were multiple 2- to 4-mm reddish brown papules with central keratotic plugs (Fig 2). Laboratory examinations for serum and urine porphyrins showed normal findings. A biopsy specimen of a bulla and a keratotic papule

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