Necrolytic migratory erythema (NME) is an uncommon inflammatory
dermatosis with a distinctive clinical and histological appearance. It shows irregular
erythema,
bullae, erosion, crusts and pigmentation. While it is typically associated with
glucagonoma, some cases of NME without
glucagonoma have been reported. Herein, we report a case of
necrolytic migratory erythema associated with malabsorption 30 years after ileocolectomy. She presented erosive
erythema with scale or partly flaccid
bullae on her intergluteal cleft, buttock and extremities. Her laboratory data revealed
essential amino acid deficiency and a slightly decreased serum
zinc level, while her plasma
glucagon level was low. With diagnosis of non-
glucagonoma-associated NME with malabsorption due to
short-bowel syndrome, she was treated and improved by i.v.
amino acid supplement. Histological findings of NME include necrotic changes of keratinocytes in the upper epidermis, proliferation of those in the lower epidermis and inflammatory cell infiltration of upper dermis. We also examined the expression pattern of epidermal
keratins (K6, K10) and Ki-67, one of the markers of proliferative activity, to assess the proliferation and differentiation of keratinocytes in a NME lesion by immunostaining. The findings with these immunostainings support the characteristics of HE-staining, and suggest hyponutrition may induce changing differentiation/proliferation of keratinocytes.