Necrolytic acral erythema: A rare entity
Keywords:
Necrolytic acral erythema, hepatitis C virus infection, interferon, ribavirinAbstract
Necrolytic acral erythema (NAE) is a rare but distinct clinical entity. It is one of the necrolytic erythemas that presents with itchy well-defined, dusky, erythematous to violaceous papules and plaques on acral areas. We report a case of a 50-year-old woman with 8-year history of itchy hyperpigmented papules and plaques on dorsum of both feet. Later, she developed similar lesions on both hands along with hemorrhagic blisters and purpura. She was found to be a hepatitis C virus (HCV) positive case. Histopathological findings were consistent with necrolytic acral erythema. She was treated with topical tacrolimus, oral zinc and cetirizine, and referred to medical outpatient department for treatment of HCV infection i.e. interferon and ribavirin. ons on both hands along with hemorrhagic blisters and purpura. She was found to be a hepatitis C virus (HCV) positive case. Histopathological findings were consistent with necrolytic acral erythema. She was treated with topical tacrolimus, oral zinc and cetirizine, and referred to medical outpatient department for treatment of HCV infection i.e. interferon and ribavirin.References
Rustin M, Cerio R. Necrolytic migratory erythema. In: Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D. Rook's Textbook of Dermatology, 9th edn. Oxford: Wiley Blackwell; 2016. P. 47.13-47.16
Shumez H, Prasad PVS, Kaviarasan PK, Viswanathan P. Necrolytic acral erythema: high degree of suspicion for diagnosis. Int J Med Res Health Sci. 2015;4:435-8.
El Darouti M, Abu El Ela M. Necrolytic acral erythema: a cutaneous marker of viral hepatitis C. Int J Dermatol. 1996;35:252-6.
Hayat W, Zahra K, Malik LM, Azfar NA, Jahangir M. Necrolytic acral erythema: an unusual cutaneous presentation of hepatitis C virus infection. J Pak Assoc Dermatol. 2012;22:66-9.
Yost JM, Boyd KP, Patel RR, Ramachandran S, Franks AG Jr. Necrolytic acral erythema. Dermatol Online J. 2013;19(12):20709
Bentley D, Andea A, Holzer A, Elewski B. Lack of classic histology should not prevent diagnosis of necrolytic acral erythema. J Am Acad Dermatol. 2009;60:504-7.
Abdallah MA, Ghozzi MY, Monib HA, Hafez AM, Hiatt KM et al. Necrolytic acral erythema: a cutaneous sign of hepatitis C virus infection. J Am Acad Dermatol. 2005;53:247-51.
Tabibian JH, Gerstenblith MR, Tedford RJ, Junkins-Hopkins JM, Abuav R. Necrolytic acral erythema as a cutaneous marker of hepatitis C: Report of two cases and review. Dig Dis Sci. 2010;55:2735-43.
Khanna VJ, Shieh S, Benjamin J, Somach S, Zaim MT, Dorner W Jr et al. Necrolytic acral erythema associated with hepatitis C: effective treatment with interferon alfa and zinc. Arch Dermatol. 2000;136:755-7.
Abdallah MA, Hull C, Horn TD. Necrolytic acral erythema: A patient from the United States successfully treated with oral zinc. Arch Dermatol. 2005;141:85-7.
Najarian DJ, Lefkowitz I, Balfour E, Pappert AS, Rao BK. Zinc deficiency associated with necrolytic acral erythema. J Am Acad Dermatol. 2006;55(5 Suppl):S108-10.
Raphael BA, Dorey-Stein ZL, Lott J, Amorosa V, Lo Re V 3rd, Kovarik C. Low prevalence of necrolytic acral erythema in patients with chronic hepatitis C virus infection. J Am Acad Dermatol. 2012;67(5):962-8.
Panda S, Lahiri K. Seronegative necrolytic acral erythema: A distinct clinical subset? Indian J Dermatol. 2010;55:259-61.
Pernet C, Guillot B, Araka O, Dereure O, Bessis D. Necrolytic acral erythema following hepatitis B vaccination. Br J Dermatol. 2014;171:1255-6.
Khattak MF, Salamat N, Bhatti FA, Qureshi TZ. Seroprevalence of hepatitis B, C and HIV in blood donors in northern Pakistan. J Pak Med Assoc. 2002;52:398-402.
