The treatment of Kyrle's disease: a systematic review

Abstract

Kyrle's disease (KD) is a cutaneous disease that develops in individuals with underlying systemic disease, particularly chronic renal failure and diabetes mellitus (DM), and is associated with a high burden of disease linked to itch. The intensely pruritic, hyperkeratotic papulonodular rash seen in KD dramatically impairs patients’ quality of life and increases their risk of mortality. Unfortunately, no guidelines or evidence‐based regimens have been specifically developed for KD, making the treatment of this disease particularly challenging for physicians. This article aims to provide the first comprehensive, up‐to‐date overview and analysis of treatment options employed for KD. A search of the PubMed/MEDLINE and Scopus databases was performed for articles regarding the treatment of KD, published in English between 1990 and 2019. Seventy‐three articles were identified, of which eighteen met the inclusion criteria. We discovered that a wide variety of treatment regimens for KD have been reported in the literature, including oral antibiotics, immunosuppressants, phototherapy, topical/systemic retinoids, topical keratolytics and various combination therapies, which include some of the aforementioned treatments, in conjunction with oral/topical/injectable steroids, emollients and/or antihistamines. The use of a combination regimen is the most commonly practiced therapeutic approach to KD. Topical corticosteroids and depot corticosteroid injections repeatedly appeared in many of the regimens encountered during our search. While no definitive recommendations can be made based on existing literature, this article provides physicians with a summative outline that can help guide management and be referenced when other treatment efforts fail. The increasing prevalence of renal disease, DM and other chronic diseases will inevitably lead to rising rates of KD in the upcoming years. While randomized controlled trials are greatly needed, novel antipruritic immunomodulatory drugs targeting specific interleukin receptors (IL‐4/13/31) and intracellular signalling (e.g. Janus kinase) pathways may have a potential role in the treatment of this disease.

Cutaneous drug reactions in the Dermatology-STD department of the University Hospital of Conakry (Guinea): responsibility of antiretroviral drugs

“…Un traitement par clindamycine pendant 04 semaines, a été tenté avec succès dans une observation [3]. Les traitements systémiques (méthotrexate, corticostéroïdes systémiques, chloroquine, rétinoïdes systémiques: acitrétine et isotrétinoïne, thalidomide, allopurinol, doxycycline, et la photothérapie) ont été tentés dans des cas isolés avec des résultats variables [10,12,13,14].…”

Western and complementary alternative medicine treatment of uremic pruritus

“…Severe scratching results in secondary skin changes, such as ulcerations, linear crust, impetigo, papules, and prurigo nodularis [ 3 ]. Approximately 10% of dialysis patients will develop Kyrle's disease, an acquired perforating dermatosis [ 5 ]. Laboratory findings suggestive of UP may include elevated blood urea nitrogen, calcium/phosphate or parathyroid hormone (PTH) [ 6 7 ].…”

The diagnostic process of Kyrle’s disease in a 65-year-old patient

“…Diabetes is the main disorder correlating with Kyrle’s disease. However, it also occurs in patients with impaired renal function (it is estimated that about 10% of patients on dialysis develop the disease), or liver or congenital heart disease [ 3 , 4 ].…”