Necrolytic Acral Erythema Associated With Hepatitis C

Vj, Khanna; Shieh, Sheng-Renn; Benjamin, James W.; Somach, Stephen C.; Mt, Zaim; Dorner, William; Shill, Martin; Gs, Wood

doi:10.1001/archderm.136.6.755

Cited by 60 publications

(21 citation statements)

References 4 publications

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“…Oral zinc therapy has been reported for its efficacy in NAE throughout the world. [ 17 18 19 ] This is where our cases resembled NAE although they differed to some extent clinically and markedly in HPE.…”

Section: Discussionmentioning

confidence: 57%

Zinc-responsive acral hyperkeratotic dermatosis-A novel entity or a subset of some well-known dermatosis?

Ghosh

Aggarwal

et al. 2015

Indian J Dermatol

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Background:We are reporting a series of interesting cases, which presented to us with psoriasiform lesions distributed over the acral regions of the body. The cases are unusual because they were resistant to conventional treatment modalities like topical corticosteroids, tacrolimus and oral methotrexate but showed significant improvement on oral zinc therapy.Materials and Methods:Ten patients with characteristic clinical features of distinctive hyperkeratotic plaque in the acral areas, who were resistant to treatment by different modalities including potent topical steroids and oral methotrexate, were included for detailed investigations. A proper history was taken and relevant laboratory investigations were done which included blood count, urine, liver function, renal function, hepatitis-C virus serology and serum zinc levels. Patients were followed up every 2 weeks. Histopathological examinations of the lesional tissue were done at baseline and after 6 weeks of therapy. Patients were given oral zinc daily and no other treatment during the 6 weeks course.Results:All our patients were non-reactive to hepatitis-C. Of the ten patients only one patient (10%) showed low titer of serum zinc, another (10%) showed higher zinc level, while the rest of the patients had normal zinc level. Five of our patients had chronic renal failure, one had Grave's disease and the remaining had no associated systemic illness. Histopathology mostly showed hyperkeratosis, acanthosis, prominent granular layer, spongiosis and dermal infiltrate. After 6 weeks of follow up, all patients showed rapid and remarkable therapeutic response with zinc.Conclusions:We here report a series of patients, discernible because of their uniform clinical presentation of acral hypekeratotic plaques and in showing a noticeable response to zinc. Clinical, histopathological and laboratory investigations were done to rule out diseases of similar morphology including psoriasis, acral necrolytic erythema and lichen simplex chronicus. Authors understand that further studies with greater number cases and more detailed investigations are required to establish exact etio-pathogenesis and nomenclature of this distinct subset of patients.

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Section: Discussionmentioning

confidence: 57%

Zinc-responsive acral hyperkeratotic dermatosis-A novel entity or a subset of some well-known dermatosis?

Ghosh

Aggarwal

et al. 2015

Indian J Dermatol

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“…Necrolytic acral erythema shares similar histology but classically the lesions are well circumscribed and dusky with an adherent scale. It is most classically associated with concurrent Hepatitis C infection (17). Pellagra is deficiency of niacin and classically presents as a diarrhea, dermatitis, and dementia in patients.…”

Section: Discussionmentioning

confidence: 99%

Zinc-deficiency acrodermatitis in a patient with chronic alcoholism and gastric bypass: a case report

Shahsavari

Ahmed

Karikkineth

et al. 2014

Journal of Community Hospital Internal Medicine Perspectives

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Acquired adult-onset zinc deficiency is occasionally reported in patients with malnutrition states, such as alcoholism, or malabsorptive states, such as post-bariatric surgery. The defining symptoms of hypozincemia include a classic triad of necrolytic dermatitis, diffuse alopecia, and diarrhea. We report a case of zinc deficiency in a 39-year-old man with history of gastric bypass surgery and alcoholism. For this patient, severe hypozincemia confirmed acrodermatitis, and zinc supplementation was met with gradual improvement.

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“…The pathogenesis of the disorder is unknown and the response to treatment is highly variable. Suggested treatments include amino acid and zinc, interferon-alpha, and ribavirin [129].…”

Section: Necrolytic Acral Erythemamentioning

confidence: 99%

Extrahepatic Manifestations of Hepatitis C Virus: An Extending List

Soliman

hawari

Refaey

et al. 2012

Afro-Egyptian Journal of Infectious and Endemic Diseases

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Hepatitis C virus is a hepatolymphotropic virus that was also detected in various organs of the body. Furthermore, this form of infection may be presented for the first time by an extrahepatic manifestation. Different extrahepatic manifestations for hepatitis C was described; these extend from strong associations as in mixed cryoglobulinemia to others were anecdotal finding as vitiligo was reported. The list of extrahepatic manifestations of hepatitis C is extending. In this review we tried to shade the light on this expanding list.

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Necrolytic Acral Erythema Associated With Hepatitis C

Cited by 60 publications

References 4 publications

Zinc-responsive acral hyperkeratotic dermatosis-A novel entity or a subset of some well-known dermatosis?

Zinc-responsive acral hyperkeratotic dermatosis-A novel entity or a subset of some well-known dermatosis?

Zinc-deficiency acrodermatitis in a patient with chronic alcoholism and gastric bypass: a case report

Extrahepatic Manifestations of Hepatitis C Virus: An Extending List

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