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A Diagnosis of Hepatitis C at Your Fingertips

Author: Anny Xiao, DO

A 54-year-old African American man presented to his primary care physician for a pruritic, progressively worsening rash on his feet, ankles and hands bilaterally that had been present for one year. He denied any previous medical history and took no medications. Social history was significant for a remote history of polysubstance abuse. On physical exam, there were well-demarcated hyperpigmented and depigmented hyperkeratotic papules coalescing into scaly plaques on the dorsal aspects of his ankles, feet, fingers, hands (figure above), and toes (Figures 2 and 3) bilaterally.

Laboratory evaluation revealed elevated AST 77 (normal 10-40 U/L) and ALT 99 (normal <36 U/L) and a positive hepatitis C antibody. Quantitative hepatitis C viral RNA level was 3,023,930 IU/mL (normal <615 IU/mL). The patient was referred to a gastroenterologist for evaluation and treatment of hepatitis C infection.


Which of the following is FALSE regarding necrolytic acral erythema?

  1. The skin lesions are primarily found on acral sites
  2. The skin lesions present as painful or pruritic, pink to violet-brown plaques with hyperkeratosis
  3. Almost all reported cases have been associated with hepatitis C viral infection
  4. Treatment options include interferon-α, interferon-α plus ribavirin, and oral iron supplementation

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Brief bio:

Anny Xiao, D.O. is an intern at Largo Medical Center in Largo, FL. She is originally from Berkeley, California, and is a recent graduate of Touro University California. She is pursuing a career in dermatology.