Reuters Health Information (2005-08-05): Necrolytic acral erythema: a cutaneous sign of HCV infection
Necrolytic acral erythema: a cutaneous sign of HCV infection
Last Updated: 2005-08-05 17:34:05 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Necrolytic acral erythema
is a distinctive skin disorder invariably associated with hepatitis C
virus infection (HCV), making it a useful clue to the diagnosis,
investigators report in the Journal of the American Academy of
Dermatology this month.
Recognition of necrolytic acral erythema "should alert practitioners
to the need for viral testing and appropriate counseling of patients,"
Dr. Mahmoud A. Abdallah from Ain Shams University in Cairo and
colleagues conclude. In all cases reported to date, necrolytic acral
erythema has been associated with HCV infection.
In their report, Dr. Abdallah and colleagues describe 30 Egyptian
patients with the cutaneous disorder. "Diagnostic clinical findings
include strikingly well-defined erythematous to hyperpigmented plaques
with scale and erosion in a unique distribution on the dorsal aspect of
the feet, extending proximally along the leg and distally to discretely
involve the dorsal aspect of the toes, particular the great toe," they
"Although other regions may be involved, this pattern on the legs
and feet was characteristic and diagnostic," the investigators point
The clinical presentation of HCV-associated necrolytic acral
erythema differs from psoriasis in that the palms, soles, nail plate,
nail bed, and distal toe remain unaffected.
The general histologic pattern of the disease, on the other hand,
resembles psoriasis. "Skin biopsy specimens from fully evolved lesions
displayed psoriasiform changes in association with more characteristic
findings of keratinocyte necrosis and papillomatosis," Dr. Abdallah and
Necrolytic acral erythema, the researchers contend, should join the
list of disorders specifically associated with HCV infection, although
the incidence the skin disease among HCV-infected patients is currently
unknown. Recognizing the clinical and histologic findings of this
disorder is important in targeted testing for HCV infection,
institution of treatment and potentially limiting the spread of the
virus, they conclude.
J Am Acad Dermatol 2005;53:247-251.