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Indian Dermatol Online J 2021 Nov-Dec;12(6):892-895. Epub 2021 Nov 22.

Department of Dermato-Venereo-Leprology, Government Medical College and Hospital, Nagpur, Maharashtra, India.

Chronic acral hyperkeratotic dermatosis includes several conditions such as lichen simplex chronicus (LSC), hypertrophic lichen planus (HLP), psoriasis vulgaris (Ps), acral acanthosis nigricans, acquired zinc deficiency, and necrolytic acral erythema (NAE). LSC, Ps, and HLP respond to conventional treatments such as topical corticosteroids, immuno-modulators such as tacrolimus, and oral methotrexate. Zinc-responsive acral hyperkeratosis is a novel entity that resembles the above mentioned diagnoses clinically but fails to respond to the above treatment options. Read More

Gastroenterology 2021 07 1;161(1):38-39. Epub 2021 Apr 1.

Department of Dermatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.

Hautarzt 2021 Apr 4;72(4):299-306. Epub 2021 Mar 4.

Medizinische Klinik B, Universitätsklinikum Münster, Münster, Deutschland.

Skin is commonly affected by neuroendorine paraneoplastic syndromes (PNS). This is due to the expression of receptors in the skin by which abnormally secreted neuroendocrine hormones and mediators elicit directly, and indirectly, cutaneous key signs and thus facilitate early diagnosis of these diseases. In acromegaly, induction of the growth hormone-insulin-like growth factor‑1 axis results in trophic changes of the acral portions of the skin and mucosal membranes including cutis verticis gyrata. Read More

JAAD Case Rep 2020 Nov 6;6(11):1162-1164. Epub 2020 May 6.

The Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York.

Clin Pract Cases Emerg Med 2020 Aug;4(3):491-492

Virginia Commonwealth University Health Systems, Department of Emergency Medicine, Richmond, Virginia.

Case Presentation: A 58-year-old female with history of hepatitis C virus presented to the emergency department with a bilateral skin eruption to her feet for one year. Following skin biopsy, the patient was diagnosed with Necrolytic acral erythema (NAE). She was treated with clobetasol ointment, zinc supplementation, and mupirocin, which resulted in improvement in her symptoms. Read More

JAMA Dermatol 2020 11;156(11):1268-1270

Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Indian Dermatol Online J 2020 Mar-Apr;11(2):278-279. Epub 2020 Mar 9.

Department of Dermatology, Command Hospital, Bengaluru, Karnataka, India.

J Dermatol 2020 Jul 30;47(7):e266-e267. Epub 2020 Apr 30.

Departments of, Department of, Dermatology, Fujita Health University School of Medicine, Toyoake, Japan.

Clin Cosmet Investig Dermatol 2020 5;13:275-281. Epub 2020 Apr 5.

Department of Dermatology, Venereology and Leprosy, SN Medical College, Bagalkote 587102, Karnataka, India.

Necrolytic acral erythema (NAE) is now considered as a distinct clinical entity. It clinically presents as well demarcated hyperpigmented papules and plaques with thick adherent scales distributed symmetrically over dorsum of feet. It usually develops in patients with Hepatitis C virus (HCV) infection. Read More

An Bras Dermatol 2019 17;94(4):446-448. Epub 2019 Oct 17.

Department of Dermatology, Dermatology Hospital of Southern Medical University, Guangdong Provincial Dermatology Hospital, Guangzhou, China.

Necrolytic acral erythema is a distinct erythema that has been described as an extrahepatic manifestation of hepatitis C virus infection. Most reported cases have been in Africa, especially Egypt. We report the first case (to the best of our knowledge) of necrolytic acral erythema in a Chinese patient with HCV and HBV coinfection. Read More

Postepy Dermatol Alergol 2019 Apr 14;36(2):234-236. Epub 2019 May 14.

Department of Dermatology, University of Rzeszow, Rzeszow, Poland.

Postgrad Med J 2019 Oct 24;95(1128):563. Epub 2019 Jun 24.

Dermatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

World J Hepatol 2019 Feb;11(2):226-233

Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.

Background: Necrolytic acral erythema (NAE) is a rare dermatological disorder, which is associated with hepatitis C virus (HCV) infection or zinc deficiency. It is characterized by erythematous or violaceous lesions occurring primarily in the lower extremities. The treatment includes systemic steroids and oral zinc supplementation. Read More

Br J Dermatol 2018 08;179(2):e88

Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, China.

Dig Liver Dis 2018 Aug 12;50(8):854. Epub 2018 Mar 12.

Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address:

Clin Liver Dis 2017 08 25;21(3):555-564. Epub 2017 Apr 25.

Betty and Guy Beatty Center for Integrated Research, Inova Health System, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd Floor, 3300 Gallows Road, Falls Church, VA 22042, USA; Department of Medicine, Center for Liver Disease, Inova Fairfax Hospital, Claude Moore Health Education and Research Building, 3rd Floor, 3300 Gallows Road, Falls Church, VA 22042, USA. Electronic address:

Chronic hepatitis C virus (HCV) infection is associated with various extrahepatic manifestations, including dermatologic involvement mostly caused by immune complexes. Mixed cryoglobulinemia has a strong relationship with HCV with 95% of these patients being infected with HCV. Lichen planus is a disease of the squamous epithelium and may affect any part of the skin, with 4% to 24% of patients with lichen planus reported to have chronic HCV infection. Read More

Case Rep Dermatol 2017 Jan-Apr;9(1):69-73. Epub 2017 Mar 17.

Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Necrolytic acral erythema (NAE) is a distinctive skin disorder. The exact cause and pathogenesis is still unclear. Most studies report an association of NAE with hepatitis C virus (HCV) infection. Read More

J Eur Acad Dermatol Venereol 2017 Aug 29;31(8):1260-1270. Epub 2017 Mar 29.

Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA.

New all-oral direct-acting antivirals (DAA) have changed the hepatitis C virus (HCV) treatment landscape. Given that dermatologists frequently encounter HCV-infected patients, knowledge of the current treatment options and their utility in treating HCV-associated dermatologic disorders is important. In addition to highlighting the new treatment options, we review four classically HCV-associated dermatologic disorders - mixed cryoglobulinaemia (MC), lichen planus (LP), porphyria cutanea tarda (PCT) and necrolytic acral erythema (NAE) - and examine the role for all-oral direct-acting antiviral (DAA) regimens in their treatment. Read More

Clin Dermatol 2017 Jan - Feb;35(1):40-49. Epub 2016 Sep 10.

Emeritus Professor of Gazi University, Faculty of Medicine, Department of Dermatology, Beşevler, Ankara, Turkey.

Viruses are considered intracellular obligates with a nucleic acid RNA or DNA. They have the ability to encode proteins involved in viral replication and production of the protective coat within the host cells but require host cell ribosomes and mitochondria for translation. The members of the families Herpesviridae, Poxviridae, Papovaviridae, and Picornaviridae are the most commonly known agents for cutaneous viral diseases, but other virus families, such as Adenoviridae, Togaviridae, Parvoviridae, Paramyxoviridae, Flaviviridae, and Hepadnaviridae, can also infect the skin. Read More

An Bras Dermatol 2016 Sep-Oct;91(5):649-651

Universidade Federal de São Paulo (Unifesp) - São Paulo (SP), Brazil.

Necrolytic acral erythema is a rare skin disease associated with hepatitis C virus infection. We report a case of a 31-year-old woman with hepatitis C virus infection and decreased zinc serum level. Physical examination revealed scaly, lichenified plaques, well-demarcated with an erythematous peripheral rim located on the lower limbs. Read More

Indian Dermatol Online J 2016 Jul-Aug;7(4):304-7

Department of Dermatology, Venereology and Leprosy, Shri BM Patil Medical College, Hospital and Research Centre, BLDE University, Bijapur, Karnataka, India.

Necrolytic acral erythema (NAE) is a newly described entity, seen in patients infected with hepatitis C virus. It is characterized by its distinguishing acral distribution, psoriasiform skin eruption and histological features. Its etiopathogenesis is not fully understood though hypo amino academia, hyperglucagonemia and zinc deficiency are considered as probable causes. Read More

Arch Biochem Biophys 2016 Dec 7;611:113-119. Epub 2016 Jun 7.

Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, 409-3898, Japan.

Of all tissues, the skin has the third highest abundance of zinc in the body. In the skin, the zinc concentration is higher in the epidermis than in the dermis, owing to a zinc requirement for the active proliferation and differentiation of epidermal keratinocytes. Here we review the dynamics and functions of zinc in the skin as well as skin disorders associated with zinc deficiency, zinc finger domain-containing proteins, and zinc transporters. Read More

Int J Low Extrem Wounds 2016 Sep 5;15(3):260-2. Epub 2016 Jun 5.

Taipei Veterans General Hospital, Taipei, Taiwan National Yang-Ming University, Taipei, Taiwan.

Necrolytic acral erythema (NAE) is a recently recognized dermatosis almost exclusively associated with hepatitis C virus (HCV) infection, and closely related to zinc deficiency. We present the case of a 60-year-old man with a history of psoriasis and chronic HCV infection, who developed new lesions of NAE extending from previous elephantine psoriatic plaques on bilateral lower legs. According to previous reports, resolution of NAE has been successfully achieved by treatment of the underlying HCV infection, or the use of oral zinc therapy. Read More

Indian J Dermatol 2016 Jan-Feb;61(1):96-9

Department of Dermatology, Medical College and Hospital, Kolkata, India.

World J Hepatol 2015 Nov;7(27):2740-8

Simone Garcovich, Rodolfo Capizzi, Department of Dermatology, Policlinico A. Gemelli, Catholic University of Sacred Heart, 00168 Rome, Italy.

The association of chronic hepatitis C virus (HCV) infection with a wide spectrum of cutaneous manifestations has been widely reported in the literature, with varying strength of epidemiological association. Skin diseases which are certainly related with chronic HCV infection due to a strong epidemiological and pathogenetic association are mixed cryoglobulinemia, lichen planus and porphyria cutanea tarda. Chronic pruritus and necrolytic acral erythema are conditions that may share a possible association with HCV infection, while several immune-mediated inflammatory skin conditions, such as psoriasis, chronic urticaria and vitiligo, have been only anecdotally reported in the setting of chronic HCV infection. Read More

Am J Med 2015 Aug 8;128(8):e3-4. Epub 2015 Apr 8.

Department of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.

Indian J Dermatol 2015 Mar-Apr;60(2):136-41

Department of Dermatology, Institute of Post-Graduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India.

Background: We are reporting a series of interesting cases, which presented to us with psoriasiform lesions distributed over the acral regions of the body. The cases are unusual because they were resistant to conventional treatment modalities like topical corticosteroids, tacrolimus and oral methotrexate but showed significant improvement on oral zinc therapy.

Materials And Methods: Ten patients with characteristic clinical features of distinctive hyperkeratotic plaque in the acral areas, who were resistant to treatment by different modalities including potent topical steroids and oral methotrexate, were included for detailed investigations. Read More

Dermatol Online J 2014 Nov 15;20(11). Epub 2014 Nov 15.

Florida State College of Medicine.

Necrolytic acral erythema (NAE) is a rare cutaneous sign of hepatitis C virus infection and has recently been linked to zinc deficiency. It presents as well-demarcated erythematous plaques in a sandal-like distribution on the dorsal feet with psoriasiform epidermal hyperplasia on histology. Our patient reported a 9-month history of progressive bilateral lower extremity erythema, swelling, erosions, and nail dystrophy that failed to improve despite multiple courses of antibiotics for presumed lower extremity cellulitis. Read More

Br J Dermatol 2014 Nov 24;171(5):1255-6. Epub 2014 Sep 24.

University of Montpellier I and Department of Dermatology, St Eloi Hospital, CHU Montpellier, Montpellier, France; Department of Pathology, Gui de Chauliac Hospital, CHU Montpellier, Montpellier, France.

Dermatol Online J 2013 Dec 16;19(12):20709. Epub 2013 Dec 16.

New York University School of Medicine.

Necrolytic acral erythema is a rare, cutaneous manifestation of hepatitis C virus infection that is characterized by erythematous, violaceous or dusky papules, blisters, and/or erosions in the early stages and by well-demarcated, hyperkeratotic, targetoid plaques with a peripheral rim of macular erythema, secondary lichenification and hyperpigmentation, and overlying fine micaceous or necrotic-appearing scale in the later stages. Because most topical modalities prove ineffective, treatment of the underlying viral infection or therapeutic zinc supplementation are required for clinical improvement. Read More