Keratotic papules in chronic renal disease

Three patients with renal disease had hyperkeratotic follicular and parafollicular lesions on the extremities. Since all of these patients had renal disease, we hypothesize that an abnormality in the renal-calcium-vitamin D-parathyroid chain allows the pathologic accumulation of keratinous debris that characterizes Kyrle's disease. As with other diseases with abnormal keratin generation, the retinoids, specifically topical tretinoin, ameliorate this condition. Despite controversial reports about poor results with tretinoin therapy, our patients have had good results without recurrences and tolerated tretinoin well.