title: Necrolytic migratory erythema without glucagonoma in patients with liver disease.
abstract: BACKGROUND
  Necrolytic migratory erythema (NME) is an uncommon inflammatory dermatosis with a distinct clinical and histologic appearance. NME is usually associated with glucagonoma. Only a few cases of NME in the absence of glucagonoma have been previously reported.
  
  
  OBJECTIVE
  We sought to understand further the pathogenesis of NME by analyzing data from three patients.
  
  
  METHODS
  Three patients were examined both clinically and histopathologically.
  
  
  RESULTS
  Each patient had an extensive erythematous scaling eruption in intertriginous, perioral, and acral areas, and a markedly red, smooth tongue. Skin biopsy specimens showed confluent parakeratosis, epidermal pallor, papillary edema, and a lymphohistiocytic infiltrate. Two patients had alcoholic liver disease and one had liver dysfunction as a result of hemochromatosis. Serum albumin level was depressed, and liver enzyme values were increased in all three patients. Glucagonoma was undetectable in these patients.
  
  
  CONCLUSIONS
  In the absence of glucagonoma, hepatocellular dysfunction and hypoalbuminemia appear to be the most common factors associated with NME.
authors.affiliation: Department of Dermatology, Oregon Health Sciences University, Portland.
authors.forename: M P
authors.initials: MP
authors.lastname: Marinkovich
authors.forename: R
authors.initials: R
authors.lastname: Botella
authors.forename: J
authors.initials: J
authors.lastname: Datloff
authors.forename: O P
authors.initials: OP
authors.lastname: Sangueza
mesh_terms: D000328:Adult; D003872:Dermatitis / Q000473:pathology; D004487:Edema / Q000473:pathology; D004890:Erythema / Q000473:pathology*; D005260:Female; D005935:Glucagonoma; D006432:Hemochromatosis / Q000150:complications*; D006801:Humans; D006965:Hyperplasia; D007642:Keratosis / Q000473:pathology; D008107:Liver Diseases / Q000150:complications*; D008108:Liver Diseases, Alcoholic / Q000150:complications*; D008875:Middle Aged; D009336:Necrosis; D012709:Serum Albumin / Q000032:analysis; D014060:Tongue Diseases / Q000473:pathology
chemical_list: D012709:Serum Albumin