title: Necrolytic acral erythema: a variant of necrolytic migratory erythema or a distinct entity?
abstract: BACKGROUND
  Hepatitis C is a major health problem in Egypt. Necrolytic acral erythema (NAE) is a recently described necrolytic erythema that has a distinctive acral distribution and a uniform association with hepatitis C. Some authors believe that NAE is a distinct entity and others consider it as a variant of necrolytic migratory erythema (NME).
  
  
  METHODS
  Five patients with clinical features consistent with NAE were included in this study. The patients were subjected to skin biopsy examination, CT scan of the pancreas and a liver biopsy. Liver function tests, serum glucagon, glucose, amino acids and zinc were measured. All patients were tested for hepatitis C by enzyme-linked immunosorbent assay (ELISA) and by polymerase chain reaction (PCR).
  
  
  RESULTS
  Three patients presented with early (acute) lesions and two patients with chronic lesions. The distribution of the lesions was almost exclusively on the dorsae of the feet. Histopathological findings were similar to those of other necrolytic erythemas. Hepatitis C virus was uniformly detected in all patients. Serum glucagon was high in two patients, serum glucose was high in four patients, serum amino acids were low in three cases and serum zinc and albumin were low in two cases. Little or no improvement was reported after oral amino acid supplementation, while the response to oral zinc sulfate was moderate to good.
  
  
  CONCLUSIONS
  Necrolytic acral erythema is closely associated with hepatitis C infection. Many findings indicate that NAE seems to be a variant of NME rather than a distinct entity. Hence, an alternative proposed term could be acral NME.
authors.affiliation: Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt. ahmadnofal5@hotmail.com
authors.forename: Ahmad Abdelgawad
authors.initials: AA
authors.lastname: Nofal
authors.forename: Eman
authors.initials: E
authors.lastname: Nofal
authors.forename: Enayat
authors.initials: E
authors.lastname: Attwa
authors.forename: Ola
authors.initials: O
authors.lastname: El-Assar
authors.forename: Magda
authors.initials: M
authors.lastname: Assaf
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001707:Biopsy, Needle; D003879:Dermatologic Agents / Q000627:therapeutic use; D004890:Erythema / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis; D018937:Hepatitis C Antibodies / Q000032:analysis; D006801:Humans; D007150:Immunohistochemistry; D007868:Leg Dermatoses / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D009336:Necrosis; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D019287:Zinc Sulfate / Q000627:therapeutic use
chemical_list: D003879:Dermatologic Agents; D018937:Hepatitis C Antibodies; D019287:Zinc Sulfate