Medication Summary

The goal of treatment is to decrease the burning and pruritus and improve the appearance of the lesions of necrolytic acral erythema. Zinc sulfate,^[36]amino acid supplementation, and interferon alfa have been successful in treating necrolytic acral erythema (NAE). Topical tacrolimus has been reported as an effective treatment for necrolytic acral erythema.^[38]

Class Summary

Minerals act as enzyme cofactors and are required in metabolic processing.

Zinc

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Use sulfate or gluconate zinc salt. Zinc sulfate 4.4 mg = 1 mg of elemental zinc. Zinc gluconate 7.1 mg = 1 mg of elemental zinc.

Class Summary

Interferons are naturally occurring compounds that have both antiviral and immunomodulatory effects.

Peginterferon alfa-2a (Pegasys)

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Peginterferon alfa-2a is used in combination with ribavirin to treat patients with chronic hepatitis C who have compensated liver disease and have not previously received interferon alfa. It consists of interferon alfa-2a attached to a 40-kd branched PEG molecule. Peginterferon alfa-2a is predominantly metabolized by the liver.

Peginterferon alfa-2b (PEG Intron)

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Peginterferon alfa-2b is an Escherichia coli recombinant product. It is used to treat chronic hepatitis C in patients not previously treated with interferon alfa who have compensated liver disease. Peginterferon alfa-2b exerts cellular activities by binding to specific membrane receptors on cell surface, which, in turn, may suppress cell proliferation and may enhance phagocytic activity of macrophages. It may also increase the cytotoxicity of lymphocytes for target cells and inhibit virus replication in virus-infected cells.

Class Summary

Nucleoside analogs are drugs that interfere with the production of DNA and RNA.

Ribavirin (Virazole)

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Ribavirin is an antiviral nucleoside analog. The chemical name is D -ribofuranosyl-1H-1,2,4-triazole-3-carboxamide. Given alone, ribavirin has little effect on the course of hepatitis C. When given with interferon, it significantly augments rate of sustained virologic response.

Questions

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Media Gallery

Plaque of necrolytic acral erythema on the ankle of a male.

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Author

Fnu Nutan, MD, FACP Assistant Professor, Department of Dermatology, Virginia Commonwealth University School of Medicine

Fnu Nutan, MD, FACP is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Indian Association of Dermatologists, Venereologists and Leprologists, Society of General Internal Medicine, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Julie Zixuan Yi MD Candidate, Eastern Virginia Medical School

Julie Zixuan Yi is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Camila K Janniger, MD Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, Rutgers New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Timothy McCalmont, MD Director, UCSF Dermatopathology Service, Professor of Clinical Pathology and Dermatology, Departments of Pathology and Dermatology, University of California at San Francisco; Editor-in-Chief, Journal of Cutaneous Pathology

Timothy McCalmont, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society of Dermatopathology, California Medical Association, College of American Pathologists, United States and Canadian Academy of Pathology

Disclosure: Received consulting fee from Apsara for independent contractor.

Noah S Scheinfeld, JD, MD, FAAD † Assistant Clinical Professor, Department of Dermatology, Weil Cornell Medical College; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Assistant Attending Dermatologist, New York Presbyterian Hospital; Assistant Attending Dermatologist, Lenox Hill Hospital, North Shore-LIJ Health System; Private Practice

Noah S Scheinfeld, JD, MD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Katherine Z Holcomb, MD, MPH Dermatologist, Lupo Center for Aesthetic and General Dermatology; Clinical Assistant Professor, Department of Derrmatolgy, Tulane University School of Medicine

Katherine Z Holcomb, MD, MPH is a member of the following medical societies: American Academy of Dermatology, American Contact Dermatitis Society, American Society for Dermatologic Surgery, Louisiana Dermatological Society, Women's Dermatologic Society

Disclosure: Nothing to disclose.