Necrolytic Migratory Erythema (NME) is a rarely encountered dermatologic condition. It is the characteristic feature of a paraneoplastic syndrome associated with neuroendocrine pancreatic tumors. A case of NME initially diagnosed and treated as psoriasis is reviewed. A review of the current literature regarding NME is also included.
Objective:
The purpose of this report is to familiarize dermatologists with a rare and potentially fatal disorder. Early recognition of NME can lead to possible cure, while delayed identification of the disease is associated with metastatic disease and a poor prognosis for the patient.
Conclusion:
When evaluating the patient who presents with a dermatitis and weight loss, it is important to exercise great caution. The differential diagnosis should be reevaluated in a disease that is not responsive to first-line therapy before further treatment is considered.
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References
1.
WilkinsonDS. Necrolytic migratory erythema with carcinoma of the pancreas. Trans St.Johns Dermtol Soc1973; 59:244–250.
2.
BeckerSWKahnDRothmanS.Cutaneous manifestation of internal malignant tumors. Arch Dermatol Syphilol1942; 45:1069–1080.
3.
WermersRAFatourechiVWynneAG, The Glucagonoma Syndrome, clinical and pathologic features in 21 patients. Medicine1996; 75:53–63.
4.
SchwartzRA. Glucagonoma and pseudoglucagonoma syndromes. Int J Dermatol1997; 36:81–89.
5.
ChastainMA. The Glucagonoma Syndrome: A review of its features and discussion of new perspectives. Am J Med Sci2001; 321(5):306–320.
6.
PrinzRADorschTRLawrenceAM. Clinical aspects of glucagon producing islet cell tumour. Am J Gastroenterol1981; 76:125–131.
7.
LewisAE. The glucagonoma syndrome. Int J Dermatol1979; 18:17–22.
8.
MozellEStenzelPWolteringEA, Functional endocrine tumors of the pancreas. Clinical presentation, diagnosis and treatment. Curr Probl Surg1990; 27:310–386.
9.
StacpoolePW. The glucagonoma syndrome. Clinical features, diagnosis and treatment. Endocr Rev1981; 2:347–361.
10.
SibrackLAGoutermanIH. Cutaneous manifestation of pancreatic diseases. Cutis1978; 21:763–768.
11.
DohlstenMHallbergT.Immunological studies in a patient with the glucagonoma syndrome. Acta Med Scand1985; 218:251–255.
12.
WynickDHammondPJBloomSR. The glucagonoma syndrome. Clin Dermatol1993; 11:93–97.
13.
HuntSJNarusVTAbellE.Necrolytic migratory erythema: Dyskeratotic dermatitis, a clue to early diagnosis. J Am Acad Dermatol1991; 24:473–477.
14.
KaplanELMichelassiF.Endocrine tumors of the pancreas and their clinical syndromes. Surg Annu1986; 18:181–228.
15.
SmithAPDoolasAStarenED. Rapid resolution of necrolytic migratory erythema after glucagonoma resection. J Surg Oncol1996; 61:306–309.
16.
van der LoosTLJMLambrechtERLambersJCCA. Successful treatment of glucagonoma-related necrolytic migratory erythema with dacarbazine. J Am Acad Dermatol1987; 16:468–472.
17.
ModlinIMLewisJJAhlmanH, Management of unresectable malignant neuroendocrine tumors of the pancreas. Surg Gynecol Obstet1993; 176:507–518.
18.
MoertelCGLefkopouloMLipsitzS, Streptozotocin–doxorubicin, streptozotocin–fluorouracil, or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med1992; 316:519–523.
19.
MakowkaLTzakisAGMazzaferroV, Transplantation of the liver for metastatic endocrine tumors of the intestine and pancreas. Surg Gynecol Obstet1989; 168:107–111.
SheppardMERaimerSSTyringSK, Treatment of necrolytic migratory erythema in glucagonoma syndrome. J Am Acad Dermatol1991; 25:925–928.
22.
JockenhovelFLederbogenSOlbrichtT, The long acting somatostatin analogue octreotide alleviates symptoms by reducing posttranslational conversion of pre-pro-glucagon to glucagon in a patient with malignant glucagonoma, but does not prevent tumor growth. Clin Investig1994; 72:127–133.
RosenbaumAFlourieBChagnonS, Octreotide (SMS 201 995) in the treatment of metastatic glucagonoma: Report of one case and review of the literature. Digestion1989; 42:116–120.
25.
BewleyAPRossJSBunkerCB, Successful treatment of a patient with octreotide-resistant necrolytic migratory erythema. Br J Dermatol1996; 134:1101–1104.
26.
BlackfordSWrightSRobertsDL. Necrolytic migratory erythema without glucagonoma: The role of dietary essential fatty acids. Br J Dermatol1991; 125:460–462.
27.
BurtonJL. Zinc and essential fatty acid therapy for necrolytic migratory erythema. Arch Dermatol1993; 129:246 [letter].
