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Journal of the American Academy of Dermatology
Volume 63, n° 2
pages 259-265 (août 2010)
Doi : 10.1016/j.jaad.2009.07.050
accepted : 8 July 2009
Original Articles

Leukocytoclastic vasculitis and necrolytic acral erythema in patients with hepatitis C infection: Do viral load and viral genotype play a role?

Mohammad A. El-Darouti, MD a, , Heba M. Mashaly, MD a, Eman El-Nabarawy, MD a, Amal M. Eissa, MD a, Mona R.E. Abdel-Halim, MD a, Marwa M.T. Fawzi, MD a, Nermine H. El-Eishi, MD a, Sherine O. Tawfik, MD a, Naglaa S. Zaki, MD a, Anoud Z. Zidan, MD a, Marwa Fawzi, MD a, Mohammad Abdelaziz, MD d, Mai M.T. Fawzi, MD b, Olfat G. Shaker, MD c
a Department of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt 
b Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt 
c Department of Medical Biochemistry, Faculty of Medicine, Cairo University, Cairo, Egypt 
d Al Houd Al Marsoud Dermatology Hospital, Cairo, Egypt 

Reprint requests: Mohammad A. El-Darouti, MD, 47 Al Falaki Street, Bab El Louk, Cairo 11471, Egypt.

Leukocytoclastic vasculitis (LCV) and necrolytic acral erythema (NAE) are skin disorders associated with hepatitis C virus (HCV) infection. However, they have not been found to occur simultaneously in the same patient.


We sought to analyze the role of serum HCV-RNA levels and HCV genotype in the pathogenesis of both LCV and NAE in an attempt to assess whether these two parameters play a role in mutual exclusivity of LCV and NAE in the same patient.


The study included 11 patients with LCV and 13 with NAE, all of whom were infected with HCV. All 24 patients were evaluated for the quantitative levels of HCV-RNA, using real-time polymerase chain reaction. HCV genotyping was performed on 10 patients in each group (N = 20).


Patients with LCV had a higher prevalence of moderate and high levels of HCV-RNA viremia (P  = .038) than those with NAE. However, there was no significant difference in HCV genotype between LCV and NAE groups (P  = .211).


Small number of cases is a limitation.


Viral load seems to play a role in determining the response of the skin to HCV infection. High levels of HCV viremia were found to be significantly associated with LCV but not with NAE. HCV viremia may play a role in the development of LCV in HCV-infected patients.

The full text of this article is available in PDF format.

Key words : Hepatitis C, hepatitis C viral load, hepatitis C virus genotype, hepatitis C virus–RNA quantitative polymerase chain reaction, leukocytoclastic vasculitis, necrolytic acral erythema

Abbreviations used : HCV, LCV, NAE, PCR, UTR

 Funding sources: None.
 Conflicts of interest: None declared.

© 2009  American Academy of Dermatology, Inc.@@#104156@@