Necrolytic migratory erythema

Please help WikiDoc by adding more content here. It's easy! Click here to learn about editing.

Necrolytic migratory erythema

WikiDoc Resources for Necrolytic migratory erythema
Articles
Most recent articles on Necrolytic migratory erythema Most cited articles on Necrolytic migratory erythema Review articles on Necrolytic migratory erythema Articles on Necrolytic migratory erythema in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Necrolytic migratory erythema Images of Necrolytic migratory erythema Photos of Necrolytic migratory erythema Podcasts & MP3s on Necrolytic migratory erythema Videos on Necrolytic migratory erythema
Evidence Based Medicine
Cochrane Collaboration on Necrolytic migratory erythema Bandolier on Necrolytic migratory erythema TRIP on Necrolytic migratory erythema
Clinical Trials
Ongoing Trials on Necrolytic migratory erythema at Clinical Trials.gov Trial results on Necrolytic migratory erythema Clinical Trials on Necrolytic migratory erythema at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Necrolytic migratory erythema NICE Guidance on Necrolytic migratory erythema NHS PRODIGY Guidance FDA on Necrolytic migratory erythema CDC on Necrolytic migratory erythema
Books
Books on Necrolytic migratory erythema
News
Necrolytic migratory erythema in the news Be alerted to news on Necrolytic migratory erythema News trends on Necrolytic migratory erythema
Commentary
Blogs on Necrolytic migratory erythema
Definitions
Definitions of Necrolytic migratory erythema
Patient Resources / Community
Patient resources on Necrolytic migratory erythema Discussion groups on Necrolytic migratory erythema Patient Handouts on Necrolytic migratory erythema Directions to Hospitals Treating Necrolytic migratory erythema Risk calculators and risk factors for Necrolytic migratory erythema
Healthcare Provider Resources
Symptoms of Necrolytic migratory erythema Causes & Risk Factors for Necrolytic migratory erythema Diagnostic studies for Necrolytic migratory erythema Treatment of Necrolytic migratory erythema
Continuing Medical Education (CME)
CME Programs on Necrolytic migratory erythema
International
Necrolytic migratory erythema en Espanol Necrolytic migratory erythema en Francais
Business
Necrolytic migratory erythema in the Marketplace Patents on Necrolytic migratory erythema
Experimental / Informatics
List of terms related to Necrolytic migratory erythema

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

• Necrolytic migratory erythema has to be differentiated from Reactive gyrate erythematous eruptions, such as:
  • Erythema annulare centrifugum (EAC)
  • Erythema gyratum repens (EGR)
• Reactive (figurate or gyrate) erythemas that are associated with malignancy include:
  

Disease	Erythema Characteristics	Signs and Symptoms	Associated Conditions	Histopathology	Lab finding & Other evaluation	Prognosis
Necrolytic migratory erythema (NME)	Migratory circinate erythema/plaques with areas of necrosis and sloughing Crusted  Erythematous scaly plaques with centrifugal growth	Red erythematous scaly plaques over Perineum, distal extremities, lower abdomen, and face Spontaneous exacerbation and remission periods without knowing what the trigger is Weight loss Anemia Diabetes Diarrhea Stomatitis.	Obligatory paraneoplastic syndrome First manifestation of the rare pancreatic neuroendocrine tumor (glaucagonoma) No other association Can be misdiagnosed as: Contact dermatitis Intertrigo Inverse psoriasis Zinc deficiency Other nutritional deficiencies	Paleness and spongiosis of the upper layer of the epidermis A perivascular lymphocytic and histiocytic infiltrate Necrotic keratinocytes are common and can lead to erosions, crusting and scaling	Increased glucagon level Evaluation of the associated tumor: CT or MRI abdomen * Selective visceral angiography to localize the tumor * Positron Emission Tomography (PET) * Octreotide scintigraphy	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)	Migratory annular and configurate erythematous or polycyclic lesions Urticarial in appearance, ringed, arcuate figures 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	Infections Allergic reactions to drugs	Deep form: Mononuclear, perivascular infiltrate in the middle and lower portions of the dermis (coat sleeve-like configuration) Infiltrate is primarily of lymphocytes, but eosinophils are occasionally present Extravasation of erythrocytes is associated with endothelial swelling    No epidermal changes    Superficial: More non-specific Slight superficial perivascular lympho-histiocytic infiltrate    Focal parakeratosis and mild spongiosis with microvesiculation	No specific laboratory changes Eosinophilia of the peripheral blood, as well as tissue, can be observed in erythema annulare centrifugum associated with a drug reaction or parasitic infection    Evaluation for possible infection or drug reaction (prescribed and non-prescribed) Complete blood count Urinalysis Liver function tests Kidney function test	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	Skin eruptions Severe Generalized itching (pruritus) Scaly erythematous patches over trunk and proximal extremities, sparing the hands, feet, and face, can eventually involve the face.    Weight loss Malaise and fatigue Fever Anorexia Lymphadenopathy Headache and convulsion (intracranial metastasis) Shortness of breath (bronchogenic carcinoma)	Dermatologic conditions: Ichthyosis palmar/plantar hyperkeratosis Less frequently EGR co-present with: Pityriasis Rubra Pilaris, Bullous pemphigoid, Pemphigus vulgaris, discoid lupus eythemutosus, psoriusiform lesions, and nonspecific vesicles and bullae Tuberculosis CREST syndrome (Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia)	The epidermis: Acanthosis Focal parakeratotosis and spongiosis The dermis: Mild focal spongiosis and parakeratosis Moderate perivascular mononuclear, lymphocytic, and histiocytic infiltrate Eosinophils and melanophages have also been reported in the infiltrate Diffuse to moderate edema of the connective tissue can be seen	There are no diagnostic laboratory findings associated with erythema gyratum repens Eosinophilia is observed in 60% of cases Decreased T lymphocytes and increased B lymphocytes observed in an erythema gyratum repens patient with increased luteinizing hormone and follicle-stimulating hormone Decreased serum levels of C3 Normal percentages of B and T lymphocytes and normal T-cell function were reported in an EGR patient without cancer	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.

References

Template:WikiDoc Sources