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Zinc-Responsive Necrolytic Acral Erythema

NAE


Presentation

  • Characteristic findings on physical examination Clinical appearance depends on the stage of NAE at presentation.[dermatologyadvisor.com]
  • We present the case of a 60-year-old man with a history of psoriasis and chronic HCV infection, who developed new lesions of NAE extending from previous elephantine psoriatic plaques on bilateral lower legs.[ncbi.nlm.nih.gov]
  • RESULTS: Three patients presented with early (acute) lesions and two patients with chronic lesions. The distribution of the lesions was almost exclusively on the dorsae of the feet.[ncbi.nlm.nih.gov]
  • Patient 1 A 24-year-old male patient presented with a history of skin lesions on legs since three weeks. Skin lesions were associated with burning sensation.[idoj.in]
  • Nunley MD INTRODUCTION A 59-year-old African American male presented with a widespread pruritic skin eruption that had been present for 1 year.[jddonline.com]
Relapsing Polychondritis
  • polychondritis 733 219 Rhinophyma 737 220 Rocky Mountain spotted fever and other rickettsial infections 739 221 Rosacea 744 222 Sarcoidosis 752 223 Scabies 757 224 Scleredema 761 225 Scleroderma 764 226 Sebaceous hyperplasia 769 227 Seborrheic eczema[books.google.com]
Intravenous Drugs
  • drug use, transfusion history, unprotected sexual intercourse) and perform appropriate laboratory testing as discussed above.[dermatologyadvisor.com]
Excoriation
  • […] dermatoses 662 202 Pretibial myxedema 668 203 Prurigo nodularis 672 204 Prurigo pigmentosa 676 205 Pruritus 678 206 Pruritus ani 686 207 Pruritus vulvae 688 208 Pseudofolliculitis barbae 691 209 Pseudoxanthoma elasticum 695 210 Psoriasis 697 211 Psychogenic excoriation[books.google.com]
Trichotillomania
  • […] capitis 816 242 Tinea pedis and skin dermatophytosis 820 243 Tinea unguium 823 244 Tinea versicolor pityriasis versicolor 827 245 Toxic epidermal necrolysis and StevensJohnson syndrome 830 246 Transient acantholytic dermatosis Grover disease 834 247 Trichotillomania[books.google.com]
Confusion
  • Inquire and evaluate for the stigmata of liver disease such as jaundice, ascites, confusion, asterixis, gynecomastia, spider telangiectasias, renal dysfunction, varices, and excessive bleeding.[dermatologyadvisor.com]

Workup

Staphylococcus Aureus
  • aureus and PantonValentine leukocidin Staphylococcus aureus infections 499 154 Miliaria 505 155 Molluscum contagiosum 508 156 Morphea 512 157 Mucoceles 515 158 Mucous membrane pemphigoid 517 eumycetoma and actinomycetoma 522 160 Mycobacterial atypical[books.google.com]

Treatment

  • Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances.[books.google.de]
  • Treatment Options Treatment options are summarized in Table I . Table I.[dermatologyadvisor.com]
  • Treatment of NAE includes supplementation of oral zinc.[idoj.in]
  • According to previous reports, resolution of NAE has been successfully achieved by treatment of the underlying HCV infection, or the use of oral zinc therapy. Our patient exhibited good response to zinc therapy.[ncbi.nlm.nih.gov]
  • Efficacy of weekly oral doramectin treatment in canine demodicosis. Murayama N, Shibata K, Negata M. Vet Rec 167:63-64, 2010. 3.[cliniciansbrief.com]

Prognosis

  • Prognosis - Gianotti-Crosti syndrome The rash fades in 2-8 weeks with mild scaling. If hepatitis B is present, the liver takes between 6 months and 4 years to recover fully. Sometimes there is persistent hepatitis and long term viral carriage.[checkorphan.org]
  • However, NME presents as a hallmark clinical sign of glucagonoma syndrome. 2 Its early recognition allows for early diagnosis of the tumor and leads to a better prognosis.[dovepress.com]
  • HLA-DRB1, complement factors, and both antismooth muscle and antinuclear antibodies. 4 There have also been data to support a correlation between viral load and specific viral genotypes and NAE. 5 It is unclear if the presence of NAE relates to HCV prognosis[jddonline.com]
  • Because of its rarity (1 case/20-200 million population) late diagnosis is frequent which leads to a poor prognosis.[thedoctorsdoctor.com]
  • The kidneys, eyes, skin, and muscles are particularly affected by this disease process, which is the principal factor determining the prognosis of individuals with diabetes mellitus. 410 Microangiopathy may be involved in the pathogenesis of the pigmented[plasticsurgerykey.com]

Etiology

  • Etiology The cause of NAE is unknown, though the metabolic derangements from an HCV-infected liver are believed to play a role.[dermatologyadvisor.com]
  • […] fingers, genetics, deficiency, cell differentiation, methods, analysis, pathology, drug therapy, zinc oxide, therapeutic use, schiff bases, metabolism, cytology, transcription factors, biosynthesis, saccharomyces cerevisiae proteins, copper, immunology, etiology[rails-staging2.nubic.northwestern.edu]
  • Etiology and pathogenesis of necrolytic migratory erythema: review of the literature. MedGenMed. 2004;6(3):4. 8. Peterson LL, Shaw JC, Acott KM, Mueggler PA, Parker F.[dovepress.com]
  • The drugs being taken by these patients, a potentially important etiological aspect, have not been listed. In the author’s experience, the bullae have been subepidermal in location.[plasticsurgerykey.com]

Epidemiology

  • Global epidemiology of hepatitis C virus infection. Lancet Infect Dis 2005;5:558-67. 14. El-Ghandour TM, Sakr MA, El-Sebai H, El-Gammal TF, El-Sayed MH. Necrolytic acral erythema in Egyptian patients with hepatitis C virus infection.[idoj.in]
  • Epidemiology, clinical features and diagnosis of gastroenteropancreatic endocrine tumours. Tomassetti P, Migliori M, Lalli S, Campana D, Tomassetti V, Corinaldesi R. Department of Internal Medicine and Gastroenterology, University ol Bologna, Italy.[thedoctorsdoctor.com]
Sex distribution
Age distribution

Pathophysiology

  • Several theories have been proposed regarding the etiology and pathophysiology of NAE including hypoaminoacidemia, hyperglucagonemia, hypoalbuminemia, and low serum zinc levels.[dermatologyadvisor.com]
  • The pathophysiology of NAE with respect to HCV is unclear.[jddonline.com]
  • Until now, the exact pathophysiologic mechanisms for many of the skin changes associated with zinc deficiency are unclear.[bioline.org.br]

Prevention

  • The patient should be told to monitor for the stigmata of liver disease in order to prevent its progression. The patient’s skin must be monitored for secondary infection of skin lesions.[dermatologyadvisor.com]
  • […] fever Causes - Gianotti-Crosti syndrome The specific viruses causing Gianotti-Crosti syndrome include: * Hepatitis B infection * Epstein Barr virus (the cause of glandular fever) * Enterovirus infections * Echo viruses * Respiratory syncytial virus Prevention[checkorphan.org]
  • Recognition of this condition is important as early intervention of undetected HCV infection with antivirals may decrease the morbidity and prevents the clinical outcomes such as chronic hepatitis, hepatic cirrhosis, and hepatocellular carcinoma.[idoj.in]
  • Solar Dermatitis 185 2 Stud Tail (Feline Tail Gland Hyperplasia) 187 2 Superficial Necrolytic Dermatitis (SND, Hepatocutaneous Syndrome, Necrolytic Migratory Erythema) 189 2 Allergy Injections (Desensitization Shots, Allergy Shots) 193 2 Flea Treatment-Prevention[isbn.nu]
  • Perhaps, concomitant immunosuppression may prevent development of overt skin manifestations or perhaps zinc deficiency in these patients is never severe enough to produce symptoms.[bioline.org.br]

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