Necrolytic Acral Erythema

Abstract

Background: Necrolytic acral erythema (NAE) is a rare dermatosis which has been regarded as an early cutaneous marker of hepatitis C virus infection. The clinical manifestasion of NAE is similar to necrolytic migratory erythema, psoriasis and tinea corporis. The difference is that the patients with NAE also suffer from hepatitis C virus infection. Case: A 59 year old woman came and complained about itchy erythematous-violaceous plaques since a year ago. The patient has a history of hepatitis C infection since 2 years ago. On the superior and inferior extremities region, there were erythematous-violaceous plaques witch is partially hyperpigmentation with well-demarcated border, multiple discretes with thin scales and lichenification. Histopathological examination of the lesion obtained psoriasiform, hyperkeratosis, neutophylic microabscess, epidermal necrosis, spongiosis and infiltration of inflammatory cells in the epidermis. Discussion: Necrolytic acral erythema has been reported exclusively in patients with hepatitis C and is thought to be pathognomonic of this infection. Acute lesions often show erythema with vesicles and flaccid bullae. Chronic lesions appear as erythematous to violaceous plaques with thick scales, erosions and crust. Acral sites are predominantly involved. The histopathological examination shows psoriasiform hyperplasia epidermal, neutrophylic microabscesses, dilatation of small vessels, parakeratosis and infiltration of inflammatory cells. In this case, the physical and histopathological examination support the diagnosis of NAE.