Necrolytic Acral Erythema Treatment & Management

Updated: Jun 25, 2020
  • Author: Fnu Nutan, MD, FACP; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

The optimal treatment for necrolytic acral erythema (NAE) is the optimal treatment of hepatitis C—combination therapy with interferon and ribavirin. In one patient, ribavirin in addition to the interferon-alfa therapy improved the necrolytic acral erythema despite the presence of a continued high viral load. [27] In a study by El-Ghandour et al, interferon-alfa combined with ribavirin given to four patients caused regression of the plaques of necrolytic acral erythema in three patients and complete clearance in one patient. [21] Interferon-alfa monotherapy has been reported to be effective treatment. [33] A 2017 review of the literature noted a case report describing treatment of hepatitis C with sofosbuvir and ledipasvir that resulted in clearance of necrolytic acral erythema from the skin. [34] This report has not yet been noted by others, yet it is promising.

Patients have been responsive to oral zinc supplementation in several cases. [9, 29, 35, 36] Oral zinc supplements can be effective in patients with normal serum zinc levels. [6, 9, 35] In two cases, the combination of oral zinc and interferon-alfa therapy resulted in total clearance. [1, 33] Zinc supplementation has been shown to enhance the effects of hepatitis C treatment. [37]

Amino acid replacement therapy, both orally and parenterally, has yielded some improvement. [8, 13]

One report noted the use of cetirizine, oral zinc, topical tacrolimus, and salicylic acid with success. [32]

Disease response to corticosteroid therapy (ie, topical, intralesional, and systemic) has been poor. No benefit has been seen with topical tar or tetracycline.

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Surgical Care

A surgical approach has not been shown to be therapeutically beneficial.

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Consultations

Consultation with an infectious disease specialist, gastroenterologist, or hepatologist may be helpful for management of the hepatitis C. Consultation with a dermatologist may be helpful for diagnosis and management of cutaneous findings.

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Diet

Supplementation with zinc and amino acids has shown benefit.

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Activity

No restrictions on activity are needed for persons with this condition.

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Prevention

Preventing hepatitis C is the primary prevention for necrolytic acral erythema (NAE).

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