Necrolytic Acral Erythema in Seronegative Hepatitis C

Abstract

Necrolytic acral erythema (NAE) is a distinctive skin disorder. The exact cause and pathogenesis is still unclear. Most studies report an association of NAE with hepatitis C virus (HCV) infection. We report a 64-year-old woman who presented with chronic mildly pruritic brownish to erythematous rashes on both lateral malleoli for 7 months. The clinical and histopathological findings were compatible with NAE. However, the serologic marker for HCV was negative.

Keywords: Acral involvement; Acrodermatitis enteropathica; Glucagonoma; Hepatitis C; Necrolytic acral erythema; Pellagra.

Fig. 1

Well-defined brownish hyperkeratotic plaque with an erythematous rim located on the right lateral malleolus.

Fig. 2

Histopathological findings revealed papillated psoriasiform epidermal hyperplasia, compact hyperkeratosis, and mounds of parakeratosis with neutrophils. There was absence of a granular layer, with pale and vacuolated keratinocytes in the superficial epidermal layer and scattered necrotic keratinocytes. Hematoxylin-eosin. Original magnification ×100.

Fig. 3

Dense inflammatory cell infiltrate of mainly lymphocytes and extravasated erythrocytes, with dilated capillaries in the papillary dermis. Hematoxylin-eosin. Original magnification ×400.