Necrolytic acral erythema (NAE) is a distinctive skin disorder. The exact cause and pathogenesis is still unclear. Most studies report an association of NAE with hepatitis C virus (HCV) infection. We report a 64-year-old woman who presented with chronic mildly pruritic brownish to erythematous rashes on both lateral malleoli for 7 months. The clinical and histopathological findings were compatible with NAE. However, the serologic marker for HCV was negative.