Necrolytic Acral Erythema in Seronegative Hepatitis C

Srisuwanwattana, Ploychompoo; Vachiramon, Vasanop

doi:10.1159/000458406

Cited by 14 publications

(13 citation statements)

References 13 publications

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“…Similarly, there are controversial data about topical or systemic corticosteroids, and zinc supplementation ranging from no response to complete resolution[1]. A trial of brief systemic steroids and oral zinc supplementation and close monitoring for clinical resolution is usually warranted in patients with clinical manifestations of NAE regardless of the serum zinc levels.…”

Section: Discussionmentioning

confidence: 99%

“…Necrolytic acral erythema (NAE) is a rare dermatological entity. While the disease is frequently associated with hepatitis C virus (HCV) infection or zinc deficiency[1-4], the pathogensis is poorly understood. NAE is characterized by erythematous lesions, violaceous papules, bullae and superficial skin erosions occurring primarily in the lower extremities and dorsal feet.…”

Section: Introductionmentioning

confidence: 99%

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Necrolytic acral erythema in a human immunodeficiency virus/hepatitis C virus coinfected patient: A case report

Oikonomou

Sarpel

Abrams-Downey

et al. 2019

WJG

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BACKGROUND Necrolytic acral erythema (NAE) is a rare dermatological disorder, which is associated with hepatitis C virus (HCV) infection or zinc deficiency. It is characterized by erythematous or violaceous lesions occurring primarily in the lower extremities. The treatment includes systemic steroids and oral zinc supplementation. We report a case of NAE in a 66-year-old human immunodeficiency virus (HIV)/HCV co-infected woman with NAE. NAE is rarely reported in co-infected patients and the exact mechanisms of pathogenesis are still unclear. CASE SUMMARY A 66-year-old HIV/HCV co-infected female patient presented with painless, non-pruritic rash of extremities for one week and underwent extensive work-up for possible rheumatologic disorders including vasculitis and cryoglobulinemia. Punch skin biopsies of right and left thigh revealed thickened parakeratotic stratum corneum most consistent with NAE. Patient was started on prednisone and zinc supplementation with resolution of the lesions and improvement of rash. CONCLUSION Clinicians should maintain high clinical suspicion for early recognition of NAE in patients with rash and HCV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Necrolytic acral erythema in a human immunodeficiency virus/hepatitis C virus coinfected patient: A case report

Oikonomou

Sarpel

Abrams-Downey

et al. 2019

WJG

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“…1 However, more recent reports of NAE arising in other conditions have challenged this dogma, including evidence of NAE arising in response to certain medications, autoimmune diseases, and other chronic conditions in the absence of coexistent hepatitis C infection. [2][3][4][5] As far as we are aware, this is the first known case of NAE arising in the setting of autoimmune hepatitis.The acute stage of NAE presents as erythematous papules, plaques, and/or flaccid bullae, most commonly in an acral distribution. In the chronic phase, lesions become annular, sharply defined, hyperkeratotic, and erythematous or violaceous plaques.…”

mentioning

confidence: 82%

“…Pellagra, a sequela of niacin (vitamin B 3 ) deficiency, classically presents as a triad of diarrhea, dermatitis, and dementia. 5 The most recognizable skin findings include photo-distributed erythema that becomes hyperpigmented and a well-demarcated hyperpigmented band around the neck known as "Casal's necklace. "…”

mentioning

confidence: 99%

Hyperkeratotic Plaques of Distal Extremities as a Presenting Sign of Autoimmune Hepatitis: Answer

Morgan

Rush

Shalin

et al. 2021

The American Journal of Dermatopathology

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Necrolytic acral erythema. DISCUSSIONNecrolytic acral erythema (NAE) is a chronic, hyperkeratotic skin condition of the distal extremities first described in 1996. 1 NAE is classically associated with chronic hepatitis C based on concomitant hepatitis C infection in nearly all of the earliest reports. 1 However, more recent reports of NAE arising in other conditions have challenged this dogma, including evidence of NAE arising in response to certain medications, autoimmune diseases, and other chronic conditions in the absence of coexistent hepatitis C infection. [2][3][4][5] As far as we are aware, this is the first known case of NAE arising in the setting of autoimmune hepatitis.The acute stage of NAE presents as erythematous papules, plaques, and/or flaccid bullae, most commonly in an acral distribution. In the chronic phase, lesions become annular, sharply defined, hyperkeratotic, and erythematous or violaceous plaques. The lesions may be pruritic or have an aching or burning sensation. 3 Histologically, early lesions of NAE are characterized by necrosis of the superficial epidermis with detachment from the underlying epidermis. In chronic lesions, the development of psoriasiform epidermal hyperplasia, superficial epidermal pallor, areas of basal cell layer vacuolar degeneration, scattered foci of necrotic keratinocytes, and associated parakeratosis become apparent. 3 Of note, our case lacked significant epidermal pallor as classically seen in NAE and other nutritional deficiencies (such as necrolytic migratory erythema), which demonstrates there can be some variability in From the

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“…NAE has been considered to be a cutaneous marker of hepatitis C infection [4,5]. However, cases of NAE have been reported all over the world in those who are seronegative to the hepatitis C virus (HCV) [6,7].…”

Section: Case Reportmentioning

confidence: 99%

Zinc-responsive acral hyperkeratotic dermatosis

Rani¹,

Sharma²,

Gupta³

2022

Our Dermatol Online

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Zinc-responsive acral dermatitis is a rare entity characterized by chronic, persistent, well-defined, hyperpigmented, and hyperkeratotic plaques on the acral regions of the body. One needs to differentiate this disease from its close differentials such as necrolytic migratory erythema and pellagra. Herein, we report a case of zinc-responsive acral hyperkeratotic dermatosis in a 35-year-old female previously treated with multiple topical drugs without any significant improvement. The diagnosis of zinc-responsive dermatosis should be kept in mind in the case of treatment-refractory, hyperpigmented plaques on the hands and feet.

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Necrolytic Acral Erythema in Seronegative Hepatitis C

Cited by 14 publications

References 13 publications

Necrolytic acral erythema in a human immunodeficiency virus/hepatitis C virus coinfected patient: A case report

Necrolytic acral erythema in a human immunodeficiency virus/hepatitis C virus coinfected patient: A case report

Hyperkeratotic Plaques of Distal Extremities as a Presenting Sign of Autoimmune Hepatitis: Answer

Zinc-responsive acral hyperkeratotic dermatosis

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