Necrolytic acral erythema is a distinctive skin lesion that occurs almost exclusively with hepatitis C infection, according to a report from Egypt. Necrolytic erythemas are a group of disorders characterized clinically by erythematous lesions that frequently develop blisters and microscopically by epidermal necrolytic changes involving mostly the upper part of the epidermis. In its early stage, it appears in the form of dusky erythematous areas with flaccid blisters found particularly on the margins of the lesions.
Acute exacerbation is the rule and it is always associated with deterioration of liver function.
During acute exacerbations, blisters reappear and the burning sensation and tenderness may become intolerable. With regard to diagnosis, necrolytic acral erythema may be confused with necrolytic migratory erythema because both conditions occur with chronic active hepatitis and both conditions are associated with low levels of amino acids. Necrolytic acral erythema differs, however, because it is not annular and is restricted to the acral parts, most particularly the dorsa of the feet. The authors noted that necrolytic acral erythema may also be confused with psoriasis or erythrokeratoderma, but the absence of scales in addition to the presence of flaccid blisters and the dusky erythema can differentiate necrolytic acral erythema from these conditions. This, they noted, may indicate that the hypoaminoacidemia is not entirely related to the pathogenesis of necrolytic acral erythema.