NECROLYTIC MIGRATORY ERYTHEMA WITHOUT GLUCAGONOMA IN PATIENTS WITH LIVER-DISEASE

Background: Necrolytic migratory erythema (NME) is an uncommon inflamm atory dermatosis with a distinct clinical and histologic appearance. N ME is usually associated with glucagonoma. Only a few cases of NME in the absence of glucagonoma have been previously reported. Objective: W e sought to understand further the pathogenesis of NME by analyzing da ta from three patients. Methods: Three patients were examined both cli nically and histopathologically.Results: Each patient had an extensive erythematous scaling eruption in intertriginous, perioral, and acral areas, and a markedly red, smooth tongue. Skin biopsy specimens showed confluent parakeratosis, epidermal pallor, papillary edema, and a lym phohistiocytic infiltrate. Two patients had alcoholic liver disease an d one had liver dysfunction as a result of hemochromatosis. Serum albu min level was depressed, and liver enzyme values were increased in all three patients. Glucagonoma was undetectable in these patients. Concl usion: In the absence of glucagonoma, hepatocellular dysfunction and h ypoalbuminemia appear to be the most common factors associated with NM E.