Necrolytic migratory erythema

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Necrolytic migratory erythema

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Huda A. Karman, M.D.

Overview

Necrolytic migratory erythema (NME) is a classical symptom observed in patients with glucagonoma and is present in 80% of cases. Associated NME is characterized by the spread of erythematous blisters and swelling across areas subject to greater friction and pressure, including the lower abdomen, buttocks, perineum, and groin.

Diagnosis

Symptoms

It consists of serpiginous (slow progressing) erythematous plaques. Where the migratory edge has an "eroded" appearance. It usually starts in the Perineum.

Associated symptoms

Weight loss, anemia , mild diabetes, diarrhea and glossitis are associated. Liver metastasis is often present.

Differentiating necrolytic migratory erythema from Other Diseases

Disease Erythema Characteristics Signs and Symptoms Associated Conditions Histopathology Lab finding

& Other evaluation

Prognosis
Necrolytic migratory erythema (NME)
  • Due to the difficulty of necrolytic migratory erythema recognition, and its association with glucagonoma, diagnosis is usually delayed
  • Necrolytic migratory erythema usually resolved after the resection and treatment of the pancreatic tumor, eg.10 days after tumor resection
  • Early recognition is crucial for better diagnosis and prognosis
Erythema annulare centrifugum (EAC) [1]
  • Migratory annular and configurate erythematous

or polycyclic lesions

  • Eruption migrate at a slower rate (2 -3 mm/d) reaching up to 10 cm in diameter with central clearing
  • Cover only a small percentage of the total body surface   
  • Annular or polycyclic lesions which may begin as urticaria-like papule
  • Eventually old lesions can spontaneously resolve in several days to a few weeks while new eruptions develop.
  • The deep form of erythema annulare centrifugum has a firm, indurated border, is rarely pruritic, and has no scale
  • The superficial type of erythema annulare centrifugum has an indistinct scaly border and is usually pruritic  
  • No specific laboratory changes
  • Lesions disappear after the underlying etiology is managed (allergy, infection, malignancy)
  • if no underlying cause, lesions can recur after discontinuation of the supportive treatment
Erythema gyratum repens (EGR)
  • Migratory annular and configurate erythematous bands that form concentric rings
  • Wood grain scaly appearance
  • scales follows the leading edge of the bands
  • Eruption migrates more rapidly, 1cm/d

(Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia)

  • Skin manifestations can be improved within 48 hours of the resection of the underlying tumor with on of the following:
    • Complete cure of the skin eruption and pruritus
    • Temporary improvement then recurrence of the eruption (specially in cases of metastasis)
    • No effect of the tumor treatment on the course of EGR
      • Death can occur few weeks after the detection of the malignancy, few months, or four years as in Gammel's patient.



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