Perforating folliculitis in association with hemodialysis

Five patients developed pruritic, keratotic, perforating follicular papules and nodules within 2 months of starting maintenance hemodialysis. Clinically and histologically, the papules and nodules showed the features of perforating folliculitis with superimposed prurigo nodularis, a condition not previously described in patients on maintenance dialysis. The patients with perforating folliculitis constituted 10% of our patients on dialysis during the period of this study. Notably, all five patients were black and had chronic renal failure secondary to diabetic nephropathy. The precise pathogenesis of perforating folliculitis in these patients is unclear at this time.