Assessment of HCV-RNA in Necrolytic acral erythema in patients with hepatitis C virus infection

Abstract

Hepatitis C virus is positive-strand RNA virus and can replicate inside the liver, transmitted by apparent and inapparent parenteral procedures representing a frequent cause of liver disease worldwide. HCV exists as a multiple genotypes and is hyperendemic in Egypt. HCV infection causes acute symptoms in 15% of cases and not associated with jaundice. Chronic infection develops in 85% of cases. Both acute and chronic HCV infection may affect the hepatic and extrahepatic tissues. There are a number of diagnostic tests for hepatitis C including: HCV antibody enzyme immunoassay or ELISA, recombinant immunoblot assay and quantitative HCV RNA polymerase chain reaction (PCR). HCV RNA can be detected by PCR typically one to two weeks after infection. 40-80% of HCV can clear with INF therapy and antiviral medications, no vaccine protects against HCV infection. Numerous extrahepatic disorders have been recognized in association with HCV infection among which dermatological disease occupy a central part. NAE was first described in 1996 by El-Darouti and Abou El Ela, it was presented as a cutaneous marker for HCV infection. NAE was initially classified as one of the necrolytic erythemas, a group which includes acrodermatitis enteropathica (associated most commonly with zinc deficiency), necrolytic migratory erythema (associated most commonly with glucoagonoma syndrome), pellagra (associated most commonly with niacin deficiency) and others. A lot of clinical and histologic similarities exist between these disease entities. Clinically, NAE is categorized into 3 phases; initial stage with a scaly erythematous papule or plaque with a deep red to violaceous center and a surrounding erythematous macule, fully developed stage with erythematous to violaceous lichenified plaques having sharply defined margins surmounted by adherent scales with finely mammillated surface in less scaly areas and occasional crusts over sites of necrosis, and late stage with progressively thinner lesions and increased hyperpigmentation. The distribution of the lesions is exclusively acral and the dorsal of the feet are the predominant site in all patients.