Perforating folliculitis of hemodialysis

Three patients developed perforating skin lesions on the legs shortly after beginning hemodialysis for chronic renal failure. All had long-standing insulin-dependent diabetes mellitus and all three were white. The skin disease was refractory to all attempts at management. In one patient, however, the eruption cleared completely when hemodialysis was stopped in favor of a renal allograft transplanted from a cadaver. Clinically and histologically, some of the lesions showed evidence of prurigo nodularis, a consequence of vigorous rubbing of a discrete focus.