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January 2005

Necrolytic Acral Erythema: A Patient From the United States Successfully Treated With Oral Zinc

Author Affiliations

Author Affiliations: Department of Dermatology and Venereology, Faculty of Medicine, Ain Shams University, Cairo, Egypt (Dr Abdallah); Departments of Dermatology (Drs Hull and Horn) and Pathology (Dr Horn), College of Medicine, University of Arkansas for Medical Sciences, and Central Arkansas Veterans Healthcare System, Little Rock.

Arch Dermatol. 2005;141(1):85-87. doi:10.1001/archderm.141.1.85

Background  Recently, necrolytic acral erythema (NAE) has been described as a cutaneous marker for hepatitis C virus (HCV) infection. Only 2 cases have been reported in the United States. Successful remission has been induced only with interferon therapy with or without ribavirin.

Observations  We describe a 46-year-old, HCV-positive African American woman with well-defined, dusky, erythematous plaques on the dorsa of the feet, Achilles tendons, legs, knees, and elbows. Histologic examination revealed confluent upper epidermal necrosis, acanthosis, papillomatosis, and superficial and deep perivascular inflammation. She was diagnosed as having NAE. We induced successful disease remission with oral zinc administration. This is the third NAE case reported in the United States and the first report of disease remission with oral zinc therapy alone.

Conclusions  Since its initial description in Egypt, more cases of NAE are being reported in the United States. Increased awareness of this entity is crucial. Oral zinc might represent a less toxic alternative therapeutic option for patients with NAE.