Necrolytic Acral Erythema: Case Report and Review of the Literature

Necrolytic acral erythema is a novel member of the necrolytic erythema family found exclusively in patients with hepatitis C virus (HCV) infection. Acrally distributed, dusky, erythematous plaques with vesiculation evolve into hyperkeratotic lesions resembling psoriasis. Given the prevalence of chronic HCV infection, necrolytic acral erythema probably is a commonly encountered entity misdiagnosed as an inflammatory dermatosis. The paucity of case reports in the United States is likely the result of unfamiliarity with the condition and its viral association. We report a case of necrolytic acral erythema and review the literature summarizing its diagnosis, pathogenesis, and treatment.