Clinical

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 explain.

"Although other regions may be involved, this pattern on the legs and feet was characteristic and diagnostic," the investigators point out.

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 colleagues report.

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.