Necrolytic acral erythema: an unusual cutaneous presentation of hepatitis C virus infection

Necrolytic acral erythema (NAE) is a newly recognized dermatosis which has been regarded as early cutaneous marker of hepatitis C virus (HCV) infection. It presents as a well demarcated, dusky, symmetrically distributed erythematous to violaceous eruption with marked hyperkeratosis and lichenification associated with pruritus or burning on the dorsal aspects of feet extending to the toes. It shows clinical and histopathological resemblance to other necrolytic erythemas. We report a case of a-55-year-old woman with itchy hyperpigmented papules and plaques on the feet for the last 6 months. Histopathology showed the features of necrolytic acral erythema.