This 45-year-old man developed well defined erythematous hyperpigmented keratotic pruritic plaques on the dorsa of the feet, and the lateral aspect of ankles. The eruption led to the suspicion of Hepatitis C Virus infection which was later confirmed by serological examination and polymerase chain reaction studies. Necrolytic acral erythema was first described in 1996 and shows features indistinguishable clinically and histologically from necrolytic migratory erythema (NME). This variant of NME usually involves the lower extremities and is invariably associated with Hepatitis C Virus infection. Lesions may begin with red crusted eroded, vesicles, papules, patches, and plaques. In older lesions thick scaly plaques predominate.
symmetric well demarcated erythematous and hyperpigmented keratotic crusted plaques