title: Necrolytic acral erythema: an expanding spectrum.
abstract: Hepatitis C virus (HCV) infection is the most common chronic blood-borne viral infection in the United States. Well-described cutaneous manifestations of HCV infection include polyarteritis nodosa, porphyria cutanea tarda, type II cryoglobulinemia-associated vasculitis, pruritus, erythema nodosum, urticaria and urticarial vasculitis, lichen planus, and erythema multiforme. First described in 1996, necrolytic acral erythema (NAE) is now recognized as a cutaneous acral eruption uniquely associated with HCV infection. Most patients present with chronic, acral, erythematous, and psoriasiform lesions. Acute presentations of NAE are rare and patients may present with atypical clinical features; in these cases, suspicion for HCV infection may be delayed for weeks to months until more classic chronic lesions develop. In many cases, NAE presents before the patient has been diagnosed with HCV infection, which allows dermatologists the unique opportunity to suspect and diagnose HCV infection based on skin findings alone.
authors.affiliation: Division of Dermatology, Department of Medicine, Cooper University Hospital-University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, Camden, USA. analisa_halpern@yahoo.com
authors.forename: Analisa V
authors.initials: AV
authors.lastname: Halpern
authors.forename: Steven R
authors.initials: SR
authors.lastname: Peikin
authors.forename: Pascal
authors.initials: P
authors.lastname: Ferzli
authors.forename: Warren R
authors.initials: WR
authors.lastname: Heymann
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004890:Erythema / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology*; D006526:Hepatitis C / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology*; D012254:Ribavirin / Q000627:therapeutic use; D019287:Zinc Sulfate / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin; D019287:Zinc Sulfate