Uremic frost on the forehead.


Full blown uremic syndrome of chronic kidney disease (CKD) is seldom seen these days due to early initiation of renal replacement therapies (RRT). 


On physical examination he had uremic fetor, pericardial rub and the most striking physical finding was whitish powdery frost, which was present all over his body, especially over the face and limbs.


When the BUN level is high, the concentration of urea in sweat increases greatly... The frost consists of a white or yellowish coating of urea crystals on the beard area and other parts of the face, neck and on the trunk... It is due to eccrine deposition of urea crystals on the skin surface of patients with severe uremia... However, a history of end-stage renal disease and the white, friable, crystalline characteristics of uremic frost can make its diagnosis easy.


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