I’ve had several patients with psoriasis improve when they began dialysis for their chronic renal failure. Any insight as to what possible mechanism is at work here? — Charles Nagel,  PA-C, MPH, Huntsville, Tex.

Earlier small-sample studies (70s-90s) reported improved psoriatic lesions upon dialysis (particularly peritoneal). Mechanisms include decreased immunoglobulin G (IgG) (see Sobh et al. Nephrol Dial Transplant. 1987;2[5]:351-358), postulated removal (from bloodstream) of growth-promoting substances, psoriasis-related factors, activated polymorphonuclear leukocytes, interference with neutrophil migration (see Kuruvila et al. Indian J Dermatol Venereol Leprol. 1998;64[3]:146-149), fibronectin level (see Vasil’eva et al. Lab Delo. 1991;3:27-28), other. 

Conversely, other studies implicate dialysis-induced growth factor, cytokines, and chemokines in psoriasis development (see Yamamoto et al. J Eur Acad Dermatol Venereol. 2006;20[9]:1139-1140). Severe psoriasis independently predicts chronic kidney disease (see Wan et al. BMJ. 2013;347:f5961). Studies focusing on factors shared by both conditions could be informative. 

Current psoriasis treatment includes topical and systemic therapies (corticosteroids, emollients, retinoids, phototherapy, immunosuppressants, biologic immune modifiers, other).– Houry Puzantian,PhD; assistant professor, College of Nursing, University of Illinois at Chicago; member, Council of Advanced Practitioners of the National Kidney Foundation (189-3)

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