Necrolytic Acral Erythema

Necrolytic acral erythema is a rare dermatological condition predominantly associated with chronic hepatitis C virus (HCV) infection. First described in 1996, necrolytic acral erythema is characterized by painful, erythematous, eroded, and occasionally bullous plaques primarily affecting the acral areas, such as the hands and feet. Although not fully understood, the pathogenesis of this condition is believed to involve complex interactions between nutritional deficiencies, particularly zinc, and chronic liver disease. Necrolytic acral erythema is a crucial cutaneous marker for HCV infection, often presenting in patients with long-standing, untreated, or poorly managed HCV. The lesions are typically well-demarcated, erythematous, eroded plaques with superficial necrosis and crusting. Necrolytic acral erythema typically follows a chronic course with recurrent episodes of exacerbation and remission. Diagnosis involves a comprehensive evaluation to uncover underlying causes and metabolic abnormalities, emphasizing testing for HCV. Histological analysis may be required to differentiate necrolytic acral erythema from other similar skin conditions. Without appropriate management, the condition can persist and lead to significant discomfort and secondary infections due to impaired skin barrier. Treatment focuses on addressing the HCV infection and the skin lesions, with oral zinc therapy showing significant effectiveness. Despite its apparent association with HCV, necrolytic acral erythema remains poorly understood and underreported, making its prevalence and incidence challenging to determine.