Arterio-venous shunt dermatitis in chronic renal failure patients on maintenance haemodialysis

Seven (8%) of 88 patients in chronic renal failure on chronic haemodialysis had arterio‐venous (A‐V) shunt dermatitis. All were cumulative insult irritant contact dermatitis from soaps, disinfectants and alcohol used for skin cleansing during haemodialysis. None of the five patients with dermatitis who were patch tested had positive responses. The mean time on haemodialysis in those patients with A‐V shunt dermatitis (4 years) was longer than in those patients without dermatitis (3 years). No patient with dermatitis had a history of atopy whereas its prevalence was 19% in patients without dermatitis. A‐V shunt dermatitis was commoner in patients with pruritus, a common problem in patients in chronic renal failure requiring haemodialysis (29% in patients with pruritus vs. 17% in patients without pruritus). Four patients with A‐V shunt dermatitis responded to treatment with mild topical steroids and substitution of normal saline for skin cleansing prior to haemodialysis.