Necrolytic Acral Erythema

Diagnosis: Necrolytic Acral Erythema

Slightly erythematous, hyperpigmented, lichenified confluent papules and plaques with adherent scales.

Clinical Presentation

Slightly erythematous, hyperpigmented, lichenified confluent papules and plaques with adherent scales.

Clinical History

Submitted by Alaa Saad. Originally posted January 16, 2011.

Treatment

See case discussion.

Differential Diagnosis

• Necrolytic migratory erythema (glucagonoma) • Psoriasis (acral) • Pellagra • Acrodermatitis enteropathica • Zinc deficiency • Contact dermatitis

Key Learnings

• Considered pathognomonic for hepatitis C infection — virtually all patients have HCV • Well-demarcated, hyperkeratotic, erythematous plaques on dorsal feet (acral distribution) • Histology resembles necrolytic migratory erythema — superficial necrosis of epidermis • Zinc supplementation may improve skin findings even before HCV treatment • Responds to HCV treatment (DAAs) • Must distinguish from glucagonoma-associated necrolytic migratory erythema

Tags: necrolytic, acral, erythema, alaa saad