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Necrolytic Acral Erythema Associated With Hepatitis C
Effective Treatment With Interferon Alfa and Zinc
Vikram J. Khanna, MD;
Sherry Shieh, MD;
Jaye Benjamin, MD;
Stephen Somach, MD;
M. Tarif Zaim, MD;
William Dorner, Jr, MD;
Martin Shill, MD;
Gary S. Wood, MD
Arch Dermatol. 2000;136:755-757.
Background Necrolytic acral erythema is a recently described necrolytic erythema that is unique in its exclusive acral location and strong association with hepatitis C.
Observation We report the first case of necrolytic acral erythema in the United States. The patient is a 43-year-old black woman who presented with a 4-year history of tender, flaccid blisters localized to the dorsal aspect of her feet. Serum zinc and glucagon levels were normal. Serum antibodies were positive for hepatitis C, and a liver biopsy specimen showed chronic hepatitis. She was successfully treated with interferon alfa-2b and zinc. We review all previously reported cases.
Conclusions Necrolytic acral erythema is a distinct entity. In a review of the literature, most patients were between 35 and 55 years of age, although 1 patient was 12 years old. Five of 8 patients were female. Four of 7 patients described previously were treated with variable success using oral zinc sulfate and amino acids, whereas 2 were successfully treated with interferon alfa. All patients were infected with hepatitis C. Necrolytic acral erythema appears to be a skin disorder linked to infection with hepatitis C virus that responds to treatment with interferon alfa and oral zinc.
From the Departments of Dermatology (Drs Khanna, Benjamin, and Wood), Internal Medicine (Dr Shieh), and Pathology (Drs Zaim and Wood), General Medical Sciences (Oncology) (Dr Wood), Case Western Reserve University, University Hospitals of Cleveland, Louis Stokes Cleveland Veterans Affairs Medical Center, Department of Dermatology, Metro Health Medical Center, Campus of Case Western Reserve University (Dr Somach), Cleveland, Ohio; and Division of Gastroenterology, Akron General Medical Center, Akron, Ohio (Dr Shill). Dr Dorner is retired from private practice in Akron, Ohio.
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