Hepatitis C–induced necrolytic acral erythema (NAE)
D. Prescribe oral zinc therapy
The keys to the correct diagnosis in this case were the childhood history of a red blood cell transfusion associated with acquisition of HCV, the dorsal distribution of lesions, and intraepidermal necrosis on the biopsy.1,2 In patients with hepatitis C–induced NAE, the combination of hypertrophic verrucous plaques and microscopic findings of psoriasiform hyperplasia commonly result in the misdiagnosis of psoriasis, eczematous dermatitis, or hypertrophic lichen planus.3 Because the punch biopsy provided diagnostic information, an incisional biopsy (choice A) was not required. Additionally, the case offers no clinical indications for the use of antibiotics (choice B) or further imaging (choice C).