Nofal Ahmad Abdelgawad, Nofal Eman, Attwa Enayat, El-Assar Ola, Assaf Magda
Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Int J Dermatol. 2005 Nov;44(11):916-21. doi: 10.1111/j.1365-4632.2004.02232.x.
Hepatitis C is a major health problem in Egypt. Necrolytic acral erythema (NAE) is a recently described necrolytic erythema that has a distinctive acral distribution and a uniform association with hepatitis C. Some authors believe that NAE is a distinct entity and others consider it as a variant of necrolytic migratory erythema (NME).
Five patients with clinical features consistent with NAE were included in this study. The patients were subjected to skin biopsy examination, CT scan of the pancreas and a liver biopsy. Liver function tests, serum glucagon, glucose, amino acids and zinc were measured. All patients were tested for hepatitis C by enzyme-linked immunosorbent assay (ELISA) and by polymerase chain reaction (PCR).
Three patients presented with early (acute) lesions and two patients with chronic lesions. The distribution of the lesions was almost exclusively on the dorsae of the feet. Histopathological findings were similar to those of other necrolytic erythemas. Hepatitis C virus was uniformly detected in all patients. Serum glucagon was high in two patients, serum glucose was high in four patients, serum amino acids were low in three cases and serum zinc and albumin were low in two cases. Little or no improvement was reported after oral amino acid supplementation, while the response to oral zinc sulfate was moderate to good.
Necrolytic acral erythema is closely associated with hepatitis C infection. Many findings indicate that NAE seems to be a variant of NME rather than a distinct entity. Hence, an alternative proposed term could be acral NME.
丙型肝炎是埃及的一个主要健康问题。坏死松解性肢端红斑（NAE）是一种最近被描述的坏死性红斑，具有独特的肢端分布且与丙型肝炎有一致的关联。一些作者认为NAE是一种独特的疾病实体，而另一些人则认为它是坏死松解性游走性红斑（NME）的一种变体。
本研究纳入了5例临床特征符合NAE的患者。对患者进行了皮肤活检、胰腺CT扫描和肝活检。检测了肝功能、血清胰高血糖素、葡萄糖、氨基酸和锌。所有患者均通过酶联免疫吸附测定（ELISA）和聚合酶链反应（PCR）检测丙型肝炎。
3例患者出现早期（急性）病变，2例患者出现慢性病变。病变几乎仅分布于足背。组织病理学发现与其他坏死性红斑相似。所有患者均一致检测到丙型肝炎病毒。2例患者血清胰高血糖素升高，4例患者血清葡萄糖升高，3例患者血清氨基酸降低，2例患者血清锌和白蛋白降低。口服补充氨基酸后改善甚微或无改善，而口服硫酸锌的反应为中度至良好。
坏死松解性肢端红斑与丙型肝炎感染密切相关。许多发现表明，NAE似乎是NME的一种变体，而非一种独特疾病实体。因此，一个建议的替代术语可以是肢端NME。
