How to Deal with Itchy Skin when on Dialysis

Four Methods:Applying Lotions and CreamsTaking Soothing BathsMaking Lifestyle ChangesManaging Itchy Skin with Medication

Some people who are undergoing hemodialysis or peritoneal dialysis will develop itchy skin, or uremic pruritus. If you are one of these people, there are several ways that you can relieve your sensitive and itchy skin. By applying soothing lotions, soaking in baths, making lifestyle modifications, or taking medication, you can begin feeling comfortable in your own skin again.

Method 1
Applying Lotions and Creams

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    Consider using calamine lotion. Calamine lotion, which includes products like lanolin or Aquaphor, is designed to treat and prevent dry, rough, scaly, and itchy skin. Calamine lotion contains emollients, which help to soften and moisturize the skin while decreasing itching and flaking.[1]
    • Check the contents of calamine lotion or creams before buying. Do not use these products if you are allergic to one of the ingredients found in the lotion.
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    Apply the lotion. Check the product label for instruction and the correct usage. In general, to use calamine lotion you should shake it well before using it. Put a dab of the lotion on a soft, clean cloth for easy application. Apply the lotion to the affected ares of your skin as often as you need to, or as directed by your doctor.[2]
    • Apply the product after bathing or showering, while the skin is still damp.
    • Such creams and lotions are for external use only. Avoid contact with your eyes and other mucous membranes.
    • Ask your pediatrician before using calamine lotion on children younger than six months old.
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    Talk to your doctor before using calamine lotion if you are pregnant, planning on becoming pregnant, or are breastfeeding. Some of the chemicals found in calamine lotion may not be safe to use during pregnancy, or may interfere with conception.
    • Additionally consult your doctor if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplements because the lotion could cause an interaction with the drugs you are already taking.
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    Consider using tacrolimus ointment. Tacrolimus ointment seems to be a safe and highly effective short‐term treatment option for patients suffering from severe itchy skin caused by dialysis. However, considering the potentially carcinogenic effect of systemically administered tacrolimus, you should not use this lotion over long periods of time.[3]
    • Consult your physician if you have existing skin infections (eg, chickenpox, herpes, shingles) at the application site, or certain skin problems (such as a precancerous skin condition, skin cancer, or Netherton syndrome).
    • There are certain medications that interact with this kind of cream, so consult your doctor before use. Certain calcium channel blockers (eg, diltiazem), cimetidine, erythromycin, fluconazole, itraconazole, or ketoconazole may increase the risk of tacrolimus ointment's side effects in certain patients.
    • Like other creams and lotions ask your physician if you should use Tacrolimus ointment if you are pregnant, planning to become pregnant, or breast-feeding.
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    Apply Tacrolimus ointment. Read the instructions that come with the ointment. You will most likely be prompted to dry your skin completely after a bath or shower before applying tacrolimus ointment. Wash your hands before using tacrolimus ointment. Apply a thin layer of the ointment to the affected area or your skin; do not apply it to any other parts of your skin. Gently rub the medicine in until it is evenly distributed. Wash your hands after applying tacrolimus ointment (if your hands are not an area of treatment).[4]
    • Do not bathe, shower, or swim right after applying tacrolimus ointment. Doing these activities could wash off the ointment. Do not cover the treated area with bandages or other dressings or wraps, unless otherwise directed by your doctor.
    • Tacrolimus ointment is for external use only. Do not get tacrolimus ointment in your eyes, nose, or mouth.
    • If you miss a dose of tacrolimus ointment, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use two doses at once.

Method 2
Taking Soothing Baths

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    Avoid using very hot water. Taking a refreshing bath at least once a day may be helpful for relieving skin itchiness and irritation. However, make sure the water you use is merely warm rather than hot, as hot water can dry your skin out further, thus causing more irritation and itchiness.[5]
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    Steer clear of fragrant soaps. Stick to soaps that are hypoallergenic, as these are especially designed for sensitive skin. Artificially fragrant soaps may cause your skin to become irritated.
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    Make a cornstarch and baking soda bath. Fill your bath-tub with warm water. Instead of using soap, simply add one half to one full cup of baking soda and a half or full cup of cornstarch to your prepared bath. Baking soda and cornstarch baths decrease itching and will dry your skin less than soap will.
    • You can add bath salts (Epsom or sea salt) to enhance your bath experience.
    • Soak in the bath for at least 15 to 20 minutes, unless told otherwise by your doctor.
    • Between baths, use cold compresses to apply pressure to itchy sites.
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    Apply soothing lotions after your bath. Dry your skin thoroughly and apply one of the lotions discussed in the previous step to help keep your skin itch-free in between baths.

Method 3
Making Lifestyle Changes

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    Consider sunlight or ultraviolet photo therapy. Sunlight, or ultraviolet light, photo therapy is thought to be able to relieve skin itchiness. However, effects seem to vary according to each patient’s individual condition.[6]
    • Our bodies need natural sunlight to synthesize vitamin D in our skin. Vitamin D is a fat-soluble vitamin. It is found in food, but also can be made by exposing your body to ultraviolet rays from the sun. The major biological function of vitamin D is to maintain normal blood levels of calcium and phosphorus (both of which can make you feel itchy).
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    Pick the best time for sun exposure. Getting at least some early morning direct sunlight is beneficial even, for people who are not undergoing dialysis. However, the highest levels of ultraviolet (UV) light occur between the hours of 9 AM and 3 PM; you should avoid getting direct sunlight without some form of skin protection during these hours. [7]
    • Because of this, you should aim to get sun exposure 10 minutes before 9 AM or in the late afternoon, after 5 PM.[8]
    • The amount of sunlight you need to make vitamin D depends on a range of factors such as the UV level, your skin type, and your lifestyle. For example, to obtain the same production of Vitamin D, the exposure to sunlight must be six times longer for a darker skinned compared to a fairer skinned person.
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    Protect your skin from sun damage during your photo therapy sessions. The same UV light that helps to synthesize vitamin D can also lead to sunburn and other skin conditions. Because of this, try not to remain outdoors for longer than 15 minutes without sun protection, such as protective lotions. Wear sunscreen on areas that are not affected by itchiness.[9]
    • Use hypoallergenic lotions or creams without SPF content to keep your skin moisturized during sun exposure. Remember if the moisturizer you use has an SPF value, it will block UVB rays, which help to sensitize vitamin D in your skin, so only apply SPF cream to areas that are not affected.
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    Wear loose-fitting garments. Lighter fabrics like cotton promote air circulation, and can help to absorb body moisture. They also work to draw heat away from your body.
    • At the same time, wearing loose clothes can help to prevent direct skin irritation caused by clothes rubbing against your skin.
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    Control your intake of phosphorus. Since dialysis does not effectively remove phosphorus, a renal diet that limits foods high in phosphorous is prescribed. In addition to controlling how much phosphorus is in your renal diet, remember to take phosphorus binders with every meal (this is discussed in the next section). Foods rich in phosphorus include[10]:
    • Dairy products like cheese, milk, and cream soups.
    • Protein like beef liver and oysters.
    • Baked, lima, and soy beans.

Method 4
Managing Itchy Skin with Medication

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    Take antihistamines. Histamine causes allergic and inflammatory reactions. This can lead to itchy skin. Antihistamines block the receptor that the histamine has to bind to to create these reactions, thereby keeping you from feeling itchy.[11]
    • Take antihistamine medications with meals to minimize stomach upset.
    • Antihistamines may cause drowsiness, so you may wish to take them at night. There are also non-drowsy versions of the same medications. These drugs may also cause your mouth to feel dry.
    • Avoid alcohol drinking while taking this drug. Antihistamines increase the sedative effect of alcohol.
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    Consider phosphate binders. Phosphate binders, also known as calcium acetate, are used to control high phosphate levels in patients with renal disease without promoting aluminum absorption. However, this medication requires a physician prescription. Your doctor will give you a specific dosage based on the amount of control you need over your phosphate and calcium levels.[12]
    • Do not take these medications within 1 to 2 hours of other medications if possible. This is to avoid drug to drug interaction with other medications. However, administer stool softeners and laxatives as prescribed because phosphate binders are constipating.
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    Take phosphate binders with a meal. Taking calcium acetate with food reduces the absorption of phosphorus, which is the goal of taking this medication. Therefore, calcium acetate should be taken with a meal.[13]
    • Do not take this medication with foods containing phosphorous (especially milk or dairy products). Avoid foods containing oxalic acid (rhubarb, spinach), or phytic acid (bran, whole cereals) because they interfere with calcium absorption.
    • Avoid drinking alcohol or caffeinated beverages because they interfere calcium absorption.


  • When using phototherapy, keep in mind that the daylight hours vary from one time of the year to another being longer during the summer and shorter in the winter. Therefore, the amount of time you need to be in the sun to make vitamin D will vary according to your location, the season and the time of day.

Sources and Citations

  2. Doenges, M., Moorhouse, M. and Murr, A. 2006. Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span. F.A Davis Company. 7th edition.
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Categories: Medication and Medical Equipment