Necrolytic Acral Erythema

Abdallah, Magda A.; Hull, Cheryl; Horn, Thomas

doi:10.1001/archderm.141.1.85

Cited by 54 publications

(12 citation statements)

References 8 publications

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“…8 However, NAE has also been observed in patients with chronic HCV in the United States. 9–10 As reported by Tabibian et al 11 , these case reports include patients with a mean age of 40 years old and describe characteristic lesions occurring on the dorsal feet, with occasional involvement of other sites, including the legs, knees, hands, and elbows. 8–16 Cutaneous lesions often cause burning, pain or itching and can be defined as acute or chronic.…”

Section: Introductionmentioning

confidence: 86%

“…8–16 Cutaneous lesions often cause burning, pain or itching and can be defined as acute or chronic. 9, 14–15 Acute lesions are described as erythematous papules, blisters, or dusky erosions that develop in a characteristic distribution. Chronic lesions present as sharply defined hyperkeratotic plaques with surrounding erythema or hyperpigmentation and occasional crusting.…”

Section: Introductionmentioning

confidence: 99%

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Low prevalence of necrolytic acral erythema in patients with chronic hepatitis C virus infection

Raphael

Dorey-Stein

Lott

et al. 2012

Journal of the American Academy of Dermatology

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Background Chronic hepatitis C virus (HCV) infection is associated with necrolytic acral erythema (NAE). However, the prevalence of NAE among HCV patients is unknown, and the clinical and histological features have not been well defined. Objective To determine the prevalence, overall clinical features, and cutaneous histopathological characteristics of NAE patients. Methods A cross-sectional study was performed among chronic HCV-infected patients cared for at three Philadelphia hospitals. Patients completed a questionnaire and underwent a dermatologic examination. All undiagnosed skin lesions with clinical features of NAE as described in the literature underwent skin biopsy. Results Among 300 patients with chronic HCV infection (median age, 55 years; 73% male; 70% HCV genotype 1), five (prevalence, 1.7%; 95% CI, 0.5 – 3.8%) had skin lesions consistent with NAE clinically, which were analyzed and confirmed with skin biopsy. All five skin biopsies demonstrated variable psoriasiform hyperplasia, mild papillomatosis, parakeratosis, and necrotic keratinocytes in the superficial epidermis. All 5 patients were >40 years old, African American males, infected with HCV genotype 1 and had a high viral load (>200,000 IU/mL). Limitations Previous descriptions of NAE were used to guide the evaluation and need for a biopsy; however, other unknown clinical characteristics of the disease may exist. The senior author was the sole interpreter of the biopsies. Only 300 of the 2500 eligible patients enrolled in the study. Conclusion The prevalence of NAE among chronic HCV patients in this sample was very low. Further research is needed to determine the etiology and appropriate therapies of NAE.

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Section: Introductionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Low prevalence of necrolytic acral erythema in patients with chronic hepatitis C virus infection

Raphael

Dorey-Stein

Lott

et al. 2012

Journal of the American Academy of Dermatology

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“…The histology of the skin in NME is very similar to the biopsy findings in deficiency states like acquired zinc deficiency, essential fatty acid deficiency, biotin deficiency and pellagra,[27] Necrolytic acral erythema, a condition strongly associated with hepatitis C presenting with erythematous patches with erosions and blisters with a predilection for the lower limbs[8] was ruled out in our patient due to a negative hepatitis C serology and presence of generalized skin lesions.…”

Section: Discussionmentioning

confidence: 52%

Necrolytic migratory ulceration

Pakran

Riyaz

2013

Indian Dermatol Online J

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Endocrine tumors of the gastroenteropancreatic system associated with specific skin manifestations are rare. We report a 53-year-old female who presented with migratory annular and arcuate ulcers on her limbs. Histopathology was similar to necrolytic erythema family which includes necrolytic migratory erythema (NME). Though initial CT scans were normal, follow up scans revealed multiple mass lesions in the tail of pancreas. Her skin lesions responded to oral zinc sulphate and monthly injections of octreotide. Prior to planned FNAC from the mass lesion, patient developed altered sensorium and succumbed to the disease. This case report seems to differ from NME clinically, due to unique finding of deep migrating ulcers which heal with scarring. ‘Necrolytic migratory ulceration’ thus appears to be a new paraneoplastic manifestation, secondary to pancreatic malignancy.

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“…Other differential diagnoses include lichen simplex chronicus and hypertrophic lichen planus (HLP) which can be diagnosed by typical clinical and histopathological features. 10,11,18 Laboratory Investigations…”

Section: Differential Diagnosismentioning

confidence: 99%

<p>Necrolytic Acral Erythema: Current Insights</p>

Inamadar¹,

Shivanna²,

Ankad³

2020

CCID

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Necrolytic acral erythema (NAE) is now considered as a distinct clinical entity. It clinically presents as well demarcated hyperpigmented papules and plaques with thick adherent scales distributed symmetrically over dorsum of feet. It usually develops in patients with Hepatitis C virus (HCV) infection. Cases of NAE have been reported in patients without HCV infection. Hepatic dysfunction resulting in metabolic alterations like hypoalbuminemia, hypoaminoacidemia, hyperglucagonemia and transient zinc deficiency has been proposed as underlying pathogenic mechanism of NAE. Clinically, NAE resembles other necrolytic erythemas like necrolytic migratory erythema (NME), acrodermatitis enteropathica (AE) and pellagra. Better understanding of etiopathogenesis and histopathological features is important to distinguish NAE from other necrolytic erythemas. The disease runs a natural course of exacerbations and remissions. Non-invasive diagnostic tools like dermoscopy can be used in differential diagnosis of NAE. Oral zinc therapy is the most effective treatment of NAE reported in most of the cases irrespective of HCV status or serum zinc levels.

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Necrolytic Acral Erythema

Cited by 54 publications

References 8 publications

Low prevalence of necrolytic acral erythema in patients with chronic hepatitis C virus infection

Low prevalence of necrolytic acral erythema in patients with chronic hepatitis C virus infection

Necrolytic migratory ulceration

<p>Necrolytic Acral Erythema: Current Insights</p>

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