Seronegative necrolytic acral erythema linked to zinc defici
The present case appears in the British Journal of Dermatology. A 36‐year‐old woman presented for evaluation of erythematous plaques on her feet for 3 years. She had obesity (body mass index 40 kg m−2), diabetes and nonalcoholic fatty liver disease.

Physical examination revealed well‐marginated hyperkeratotic erythematous plaques with inflamed borders on the dorsal aspects of the feet (a). Histopathology revealed papillomatous hyperplasia with lamellar parakeratosis and focally dyskeratotic cells, and epidermal pallor in the epidermis (b; haematoxylin and eosin, original magnification × 100).

Relevant investigations included a low serum zinc concentration (0·65 mg L−1, normal range 0·75–1·2) and absence of antibodies against hepatitis C virus (by enzyme‐linked immunosorbent assay).

Seronegative necrolytic acral erythema (NAE) was diagnosed. It is hypothesized that seronegative NAE may be linked to metabolic diseases and zinc deficiency.

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