Necrolytic Acral Erythema in an Adolescent

Abstract

In 1996 el Darouti and Abu el Ela described seven Egyptian patients with similar cutaneous lesions and proposed necrolytic acral erythema (NAE) as a distinct entity of the necrolytic erythema family. Since then, NAE has emerged as a cutaneous manifestation of hepatitis C virus infection and taken its place in the literature as a marker for systemic disease. NAE initially presents with burning, pruritic eruptions of circumscribed, erythematous papules with flaccid vesiculation on the acral surfaces universally affecting the dorsum of the feet. The presenting papules of acute NAE evolve over time into confluent, velvety, hyperkeratotic plaques with decreased central erythema but a characteristic dark erythematous rim and adherent scale. Although mostly misdiagnosed as psoriasis or inflammatory dermatitis, NAE can be definitively placed among the necrolytic erythema family as a distinct entity based on clinical and histopathologic characteristics. We report a case of necrolytic acral erythema in a 17-year-old followed by a review of the literature.

Psoriasiform plaques on the dorsa of the feet responding to zinc supplementation

“…It presents clinically as psoriasiform plaques. The most common site of involvement is the dorsa of the feet, 2 with other sites including the knees, thighs, abdomen and genitalia 3…”

“…The aetiopathogenesis of NAE is not yet fully clear. However, certain factors have been incriminated, including hypoaminoacidaemia, hyperglucagonaemia, hypoalbuminaemia, HCV infection and low serum zinc levels 2,3 . As albumin is the carrier for zinc, its deficiency can lead to zinc deficiency as well.…”

“…The differential diagnoses include psoriasis, hypertrophic lichen planus, lichen simplex chronicus, necrolytic migratory erythema and other necrolytic erythemas 2,3 …”

“…4 The differential diagnoses include psoriasis, hypertrophic lichen planus, lichen simplex chronicus, necrolytic migratory erythema and other necrolytic erythemas. 2,3 Treatment of NAE consists of oral zinc supplementation, and response is often noted in a few weeks. Tabibian et al recommended supplementation with oral zinc sulfate 220 mg twice daily as first-line therapy for NAE owing to its high rate of success, safety and low cost.…”