Acute necrotizing acral erythema associated with hepatitis C: Histopathological dermoscopic correlation

Abstract

Necrotizing acral erythema (NAE) is a rare disease associated with hepatitis C and is considered as diagnostic marker. Clinical findings are well-circumscribed hyperpigmented papules and thick adherent scaly plaques symmetrically distributed on the dorsum of the foot. From a clinical perspective, NAE shares similarities with other conditions such as necrotizing erythema migrans (NME), enteropathic acrodermatitis (AE), and pellagra. To clearly distinguish NAE from similar conditions, a better understanding of its causes and histopathological features is important. NAE often follows a pattern of worsening and improving symptoms. Dermoscopy is noninvasive and can be an important tool in differentiating NAE from other necrotizing erythema and aids in diagnosis. Oral zinc therapy is the most effective treatment method regardless of HCV infection. Here, we present rare case report of a 46-year-old male patient who presented with clear fluid bullae and surrounding erythema in the lower extremity due to HCV infection with improvement after oral zinc treatment.