Well-defined plaques with erythema on the outer rim, lichenification, secondary hyperpigmentation, and fine desquamation on the surface begin to appear in the late phase.

[3] Traditionally, necrolytic acral erythema manifests as distinct, dark red hyperkeratotic plaques with a keratotic border that are usually found on the dorsum of the foot and toes.

It has been documented that the nails, palms, and soles, features typically thought of as distinguishing characteristics against necrolytic acral erythema, are affected.

When the lesions reach a well-developed stage, they combine to create a thick, hyperpigmented plaque that is clearly defined and has adhering scales.

Early lesions from the margin display upper epidermal necrosis that has detached from the surrounding tissue in the form of blisters.