Zinc supplementation possibly resolving pancreatic metastatic tumor-associated necrolytic migratory erythema. A new therapeutic approach?




Ana L. Matos, Department of Dermatology, Coimbra University Hospital Center, Coimbra, Portugal Duarte Flor, Department of Dermatology, Coimbra University Hospital Center, Coimbra, Portugal Rebeca Calado, Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal José C. Cardoso, Department of Dermatology, Coimbra University Hospital Center, Coimbra, Portugal


Necrolytic migratory erythema (NME) is a rare skin disease typically associated with glucagonoma syndrome, although it can be associated with other non-tumoral diseases. We present the case of a 71-year-old man with a pancreatic neuroendocrine tumor diagnosed with ENM. Although zinc levels were normal, after zinc oral supplementation, there was complete resolution of NME lesions that persisted even after chemotherapy with concomitant somatostatin analog therapy. This has already, although rarely, been reported. NME pathogenesis is not yet fully understood. Hyperglucagonemia contributes to the dysfunction of the epidermis but its pathogenesis most likely results from numerous aspects including hypoaminoacidemia or zinc and essential fatty acids deficiency.



Keywords: Paraneoplastic syndromes. Necrolytic migratory erythema. Zinc. Therapeutics. Pancreatic diseases.