Necrolytic acral erythema: A cutaneous sign of hepatitis C virus infection

Abdallah, Magda A.; Ghozzi, Mohamed; Monib, Hoda A.; Hafez, A M; Hiatt, Kim M.; Smoller, Bruce R.; Horn, Thomas

doi:10.1016/j.jaad.2005.04.049

Cited by 65 publications

(119 citation statements)

References 13 publications

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“…Symptoms of NAE may include pruritus (93% of cases), burning (16% of cases), and/or pain (14% of cases). NAE presents with evolving lesions, from pronounced erythematous plaques occasionally with vesicles and flaccid bullae especially at the periphery in the acute stage to erythematous and violaceous plaques with thick scale, erosions, crusting, and often a dark red rim in the chronic stage [5,7]. The differential diagnosis for NAE, in addition to other necrolytic erythemas, may include hypertrophic lichen planus, psoriasis, eczema, hyperkeratotic allergic contact dermatitis, erythrokeratoderma, and palmoplantar keratoderma.…”

Section: Discussionmentioning

confidence: 99%

Necrolytic Acral Erythema as a Cutaneous Marker of Hepatitis C: Report of Two Cases and Review

et al. 2010

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Necrolytic acral erythema (NAE) is a member of the necrolytic erythemas, which include necrolytic migratory erythema (NME), acrodermatitis enteropathica, and various dermopathies secondary to nutritional deficiencies. NAE is distinct from the other necrolytic erythemas by virtue of its consistent association with hepatitis C (HCV) together with the acral distribution of its lesions, in particular, dorsal hands and feet. Although its etiology is unknown, NAE has been reported to respond to zinc replacement, suggesting a causal relationship. Two patients with HCV infection presented with scaly acral plaques and histopathologic features consistent with NAE while also demonstrating atypical palmoplantar accentuation of lesions. Both patients were found to have zinc deficiency, and their lesions responded to zinc supplementation. Awareness of NAE as a unique cutaneous marker for HCV infection is important not only for accurate dermatologic diagnosis but also for appropriate management of associated morbidity and prompt detection of potentially undiagnosed underlying HCV.

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Section: Discussionmentioning

confidence: 99%

Necrolytic Acral Erythema as a Cutaneous Marker of Hepatitis C: Report of Two Cases and Review

et al. 2010

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“…[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][9][10][11][12][13][14][15][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.…”

Section: Introductionmentioning

confidence: 99%

“…Chronic lesions present as sharply defined hyperkeratotic plaques with surrounding erythema or hyperpigmentation and occasional crusting. [14][15][16] In the past, histological findings on skin biopsy have shown a psoriasiform pattern, with varying degrees of epidermal thickness, papillomatosis, and superficial keratinocytic necrosis, depending on the chronicity of the biopsied lesion. 15 Although case reports have provided a clinical description of NAE, the prevalence and risk factors for development of this disease remain unknown.…”

Section: Introductionmentioning

confidence: 99%

“…[14][15][16] In the past, histological findings on skin biopsy have shown a psoriasiform pattern, with varying degrees of epidermal thickness, papillomatosis, and superficial keratinocytic necrosis, depending on the chronicity of the biopsied lesion. 15 Although case reports have provided a clinical description of NAE, the prevalence and risk factors for development of this disease remain unknown. [8][9][10][11][12][13][14][15][16] Further, the impact of available treatments has been poorly described.…”

Section: Introductionmentioning

confidence: 99%

“…15 Although case reports have provided a clinical description of NAE, the prevalence and risk factors for development of this disease remain unknown. [8][9][10][11][12][13][14][15][16] Further, the impact of available treatments has been poorly described. We therefore sought to determine the prevalence of NAE among patients with chronic HCV infection, examine risk factors for this condition, and describe the clinical characteristics and confirm the histological features.…”

Section: Introductionmentioning

confidence: 99%

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

2011

Journal of the American Academy of Dermatology

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An 18-Month History of Dorsal Foot Lesions

Moffat

Ren

Simone

2021

JAMA

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A 32-year-old Nigerian woman presented with dull pain, pruritus, and discoloration of the dorsal aspect of both feet for 18 months. Her medical history included a red blood cell transfusion as a child and 2 uncomplicated pregnancies.The lesions started as small papules on the dorsal right great toe and left third toe that gradually spread across the dorsum of her feet over the following 12 months. An over-thecounter antifungal ointment was unhelpful. Her primary care physician completed a biopsy, diagnosed verruca plantaris, and prescribed topical salicylic acid twice daily for 4 weeks. The lesions did not improve, and her foot pain worsened. Subsequent treatment with topical liquid nitrogen cryotherapy was ineffective.Three months after cryotherapy, the patient presented to the dermatology clinic regarding the lesions on her feet. The patient stated that the lesions had been stable in size for the previous 6 months, without bleeding, discharge, or change in color. She continued to have 6 of 10, dull, constant pain that was nonradiating, improved when she soaked her feet in water, and worsened with any type of topical pressure or wrapping. Physical examination revealed multiple well-circumscribed, scaly plaques with cobblestone surfaces on the dorsal aspects of the forefoot and midfoot bilaterally. Findings were more severe on the right and left hindfoot (Figure, left panel). On serologic testing, the patient was negative for HIV and positive for hepatitis C virus (HCV). A punch biopsy of the right foot lesion revealed psoriasiform epidermal hyperplasia, parakeratosis, eosinophils, papillary dermal inflammation, and intraepidermal necrosis (Figure, right panel).

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Necrolytic acral erythema: A cutaneous sign of hepatitis C virus infection

Cited by 65 publications

References 13 publications

Necrolytic Acral Erythema as a Cutaneous Marker of Hepatitis C: Report of Two Cases and Review

Necrolytic Acral Erythema as a Cutaneous Marker of Hepatitis C: Report of Two Cases and Review

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

An 18-Month History of Dorsal Foot Lesions

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