Necrolytic acral erythema: high degree of suspicion for diagnosis

Necrolytic Acral Erythema (NAE) is a recently described, poorly understood, rare dermatological entity, which is frequently associated with Hepatitis C Virus (HCV) infection. This report describes a 53 year old male with a 6 month history of well demarcated, reddish brown to hyperpigmented, scaly skin over dorsum of both hands and feet. Investigations revealed hypothyroidism and low serum zinc levels. Patient also tested seropositive for HCV. Histopathological examination revealed hyperkeratosis and subcorneal clefting along with areas of necrosis. Patient was started on oral zinc along with treatment for hypothyroidism, and improved symptomatically in 2 weeks. Early recognition of NAE is of prime importance to dermatologists as it allows diagnosis of HCV in previously unaware patients and gives way for efficacious treatment.