Necrolytic migratory erythema

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Necrolytic migratory erythema
Necrolytic migratory erythema in the gluteal area

Necrolytic migratory erythema (NME) is a red, blistering rash that spreads across the skin. It particularly affects the skin around the mouth and distal extremities; but may also be found on the lower abdomen, buttocks, perineum, and groin. It is strongly associated with glucagonoma, a glucagon-producing tumor of the pancreas, but is also seen in a number of other conditions including liver disease and intestinal malabsorption.[1]

Signs and symptoms

NME features a characteristic skin eruption of red patches with irregular borders, intact and ruptured vesicles, and crust formation.[2] It commonly affects the limbs and skin surrounding the lips, although less commonly the abdomen, perineum, thighs, buttocks, and groin may be affected.[2] Frequently these areas may be left dry or fissured as a result.[2] All stages of lesion development may be observed synchronously.[3] The initial eruption may be exacerbated by pressure or trauma to the affected areas.[2]

Associated conditions

William Becker first described an association between NME and glucagonoma in 1942[3][4] and since then, NME has been described in as many as 70% of persons with a glucagonoma.[5] NME is considered part of the glucagonoma syndrome,[6] which is associated with hyperglucagonemia, diabetes mellitus, and hypoaminoacidemia.[3] When NME is identified in the absence of a glucagonoma, it may be considered "pseudoglucagonoma syndrome".[7] Less common than NME with glucagonoma, pseudoglucagonoma syndrome may occur in a number of systemic disorders:[8]


The cause of NME is unknown, although various mechanisms have been suggested. These include hyperglucagonemia, zinc deficiency, fatty acid deficiency, hypoaminoacidemia, and liver disease.[3]


The pathogenesis is also unknown, though it is recognized that hyperglucagonemia has a role in the pathophysiology, though undetermined as yet[1]


In terms of the diagnosis of this dermatological condition, skin biopsies should be performed, as well as, physical exam, lab tests (glucagon level), imaging of abdomen and several other tests.[1]


The histopathologic features of NME include:[9]

  • Epidermal necrosis
  • Subcorneal pustules
  • Suppurative folliculitis

The vacuolated, pale, swollen epidermal cells and necrosis of the superficial epidermis are most characteristic.[3] Immunofluorescence is usually negative.[3]


Managing the original condition, glucagonoma, by octreotide or surgery. After resection, the rash typically resolves within days.[10]

See also


  1. 1.0 1.1 1.2 Foss, Michael G.; Ferrer-Bruker, Sarah J. (2021). "Necrolytic Migratory Erythema". StatPearls. StatPearls Publishing. Archived from the original on 29 August 2021. Retrieved 1 June 2021.
  2. 2.0 2.1 2.2 2.3 Thiers BH, Sahn RE, Callen JP (2009). "Cutaneous manifestations of internal malignancy". CA – A Cancer Journal for Clinicians. 59 (2): 73–98. doi:10.3322/caac.20005. PMID 19258446.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Pujol RM, Wang CY, el-Azhary RA, Su WP, Gibson LE, Schroeter AL (January 2004). "Necrolytic migratory erythema: clinicopathologic study of 13 cases". International Journal of Dermatology. 43 (1): 12–8. doi:10.1111/j.1365-4632.2004.01844.x. PMID 14693015.
  4. Becker WS, Kahn D, Rothman S (1942). "Cutaneous manifestations of internal malignant tumors". Archives of Dermatology and Syphilology. 45 (6): 1069–1080. doi:10.1001/archderm.1942.01500120037004.
  5. van Beek AP, de Haas ER, van Vloten WA, Lips CJ, Roijers JF, Canninga-van Dijk MR (November 2004). "The glucagonoma syndrome and necrolytic migratory erythema: a clinical review". Eur. J. Endocrinol. 151 (5): 531–7. doi:10.1530/eje.0.1510531. PMID 15538929.
  6. Odom, Richard B.; Davidsohn, Israel; James, William D.; Henry, John Bernard; Berger, Timothy G.; Clinical diagnosis by laboratory methods; Dirk M. Elston (2006). Andrews' diseases of the skin: clinical dermatology. Saunders Elsevier. pp. 143. ISBN 978-0-7216-2921-6.
  7. Echenique-Elizondo, Miguel; Tuneu Valls, Ana; Elorza Orúe, José L.; Martinez de Lizarduy, Ignacio; Ibáñez Aguirre, Javier (July 2004). "Glucagonoma and pseudoglucagonoma syndrome". JOP: Journal of the pancreas. 5 (4): 179–185. ISSN 1590-8577. Archived from the original on 29 August 2021. Retrieved 2 June 2021.
  8. Mignogna MD, Fortuna G, Satriano AR (December 2008). "Small-cell lung cancer and necrolytic migratory erythema". The New England Journal of Medicine. 359 (25): 2731–2. doi:10.1056/NEJMc0805992. PMID 19092164.
  9. Patterson, James W. (19 November 2019). Weedon's Skin Pathology E-Book. Elsevier Health Sciences. p. 603. ISBN 978-0-7020-7583-4. Archived from the original on 29 August 2021. Retrieved 2 June 2021.
  10. Compton, Nicholas L.; Chien, Andy J. (May 2013). "A Rare but Revealing Sign: Necrolytic Migratory Erythema". The American Journal of Medicine. 126 (5): 387–389. doi:10.1016/j.amjmed.2013.01.012. PMID 23477490.

External links

External resources