Necrolytic acral erythema as a cutaneous marker of hepatitis C: Report of two cases and review

James H. Tabibian, Meg R. Gerstenblith, Ryan J. Tedford, Jacqueline M. Junkins-Hopkins, Rachel Abuav

Research output: Contribution to journalReview article

18 Scopus citations


Necrolytic acral erythema (NAE) is a member of the necrolytic erythemas, which include necrolytic migratory erythema (NME), acrodermatitis enteropathica, and various dermopathies secondary to nutritional deficiencies. NAE is distinct from the other necrolytic erythemas by virtue of its consistent association with hepatitis C (HCV) together with the acral distribution of its lesions, in particular, dorsal hands and feet. Although its etiology is unknown, NAE has been reported to respond to zinc replacement, suggesting a causal relationship. Two patients with HCV infection presented with scaly acral plaques and histopathologic features consistent with NAE while also demonstrating atypical palmoplantar accentuation of lesions. Both patients were found to have zinc deficiency, and their lesions responded to zinc supplementation. Awareness of NAE as a unique cutaneous marker for HCV infection is important not only for accurate dermatologic diagnosis but also for appropriate management of associated morbidity and prompt detection of potentially undiagnosed underlying HCV.

Original languageEnglish (US)
Pages (from-to)2735-2743
Number of pages9
JournalDigestive Diseases and Sciences
Issue number10
StatePublished - Oct 2010
Externally publishedYes



  • Hepatitis C
  • Malnutrition
  • Necrolytic acral erythema
  • Rash
  • Zinc

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology

Cite this

Tabibian, J. H., Gerstenblith, M. R., Tedford, R. J., Junkins-Hopkins, J. M., & Abuav, R. (2010). Necrolytic acral erythema as a cutaneous marker of hepatitis C: Report of two cases and review. Digestive Diseases and Sciences, 55(10), 2735-2743.