Unusual palmoplantar blistering in the setting of hemodialysis: a case report and review of the dermatoses associated with hemodialysis.

We describe a 70-year-old White female on maintenance high-flux hemodialysis for chronic renal insufficiency with an abrupt onset of asymptomatic palmoplantar blisters. The lesions were tense, noninflamed and 0.2-1.0 cm in dimension. Concomitant photo-distributed blistering of the dorsal hands and forearms was not present. A cutaneous biopsy demonstrated nonspecific histological and direct immunofluorescent findings. Serum indirect immunofluorescence and tissue cultures for bacteria, fungi and viruses were negative. Fecal porphyrins were normal but an elevated plasma uroporphyrin level of 17.0 microg/dL (normal: < 1.0 microg/dL) was observed. The duration of each hemodialysis treatment, which the patient had continued to receive three times per week, was changed from 2 to 2.5 h. Within 2 weeks no new blisters occurred. Within 6 weeks complete clinical and biochemical remission was noted. During this time course no topical steroid or antifungal therapy was employed nor was the patient's oral medication regimen altered.