Necrolytic migratory erythema: Difference between revisions
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;Associated symptoms | ;Associated symptoms | ||
[[Weight loss]], [[anemia]] , [[mild diabetes]], [[diarrhea]] and [[glossitis]] are associated. Liver metastasis is often present. | [[Weight loss]], [[anemia]] , [[mild diabetes]], [[diarrhea]] and [[glossitis]] are associated. Liver metastasis is often present. | ||
'''Erythema Characteristics''' | |||
* Migratory circinate [[erythema]]/[[plaques]] with areas of [[necrosis]] and sloughing | |||
* Crusted [[Erythematous]] scaly plaques with centrifugal growth | |||
* '''Associated Conditions''' | |||
* Obligatory [[paraneoplastic]][[syndrome]] | |||
* First manifestation of the rare [[pancreatic neuroendocrine tumor]]([[Glucagonoma|glaucagonoma]]) | |||
* No other association | |||
** Can be misdiagnosed as: | |||
*** [[Contact dermatitis]] | |||
*** [[Intertrigo]] | |||
*** [[Psoriasis|Inverse psoriasis]] | |||
*** [[Zinc deficiency]] | |||
*** Other [[nutritional deficiencies]] | |||
'''Histopathology''' | |||
* [[Paleness]] and spongiosis of the upper layer of the [[epidermis]] | |||
* A [[Perivascular cell|perivascular]][[lymphocytic]] and [[histiocytic]] infiltrate | |||
* [[Necrotic]][[Keratinocyte|keratinocytes]] are common and can lead to erosions, crusting and [[Scaling skin|scaling]] | |||
'''Lab finding''' & Other evaluation | |||
* Increased [[glucagon]]<nowiki/>level | |||
* Evaluation of the associated [[tumor]]: | |||
** [[CT-scans|CT]] or [[MRI]][[abdomen]] | |||
* * [[Visceral angiography|Selective visceral angiography]]<nowiki/>to localize the tumor | |||
* * [[Positron Emission Tomography]](PET) | |||
* * [[Octreotide]][[scintigraphy]] | |||
'''prognosis''' | |||
* 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|pancreatic tumor,]]<nowiki/>eg.10 days after tumor resection | |||
** Early recognition is crucial for better diagnosis and prognosis Differential Diagnosis: | |||
* '''[[Erythema gyratum repens|Erythema gyratum repens (EGR)]]''' | |||
* [[Erythema annulare centrifugum|'''Erythema annulare centrifugum''' (EAC)]] <br /> | |||
==References== | ==References== | ||
Revision as of 20:54, 1 July 2019
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| Necrolytic migratory erythema |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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.
Erythema Characteristics
- Crusted Erythematous scaly plaques with centrifugal growth
- Associated Conditions
- Obligatory paraneoplasticsyndrome
- First manifestation of the rare pancreatic neuroendocrine tumor(glaucagonoma)
- No other association
- Can be misdiagnosed as:
Histopathology
- A perivascularlymphocytic and histiocytic infiltrate
- Necrotickeratinocytes are common and can lead to erosions, crusting and scaling
Lab finding & Other evaluation
- Increased glucagonlevel
- * Selective visceral angiographyto localize the tumor
- * Positron Emission Tomography(PET)
prognosis
- 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 Differential Diagnosis:
- Erythema gyratum repens (EGR)
- Erythema annulare centrifugum (EAC)
References
Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs