A Lean Lady With Acanthosis Nigricans and Uncontrolled Diabetes Mellitus

Rao, Gururaja; Chauhan, Yash V; Varthakavi, Premlata K; Bhagwat, Nikhil M

doi:10.7759/cureus.11330

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…18 Patients with Acanthosis Nigricans due to diabetes generally suffer few or no skin complications and have a good prognosis with potentially complete resolution with adequate treatment and glycemic control. 19 It can fade over time with treatment of insulin resistance and controlling blood glucose by diet and exercise as weight loss and correction of insulin resistance reduces the hyperkeratotic lesions. 20 Topical ointments using keratolytics like topical retinoids and podophyllin may aid in lightening skin in selected patients mainly for cosmetic reasons.…”

Section: Resultsmentioning

confidence: 99%

Acanthosis Nigricans in Patients with Type II Diabetes Mellitus at a Tertiary Care Hospital of Lahore

Butt¹,

Mahmood²,

Kanwal³

et al. 2022

J. Bahria Uni. Med. Dent. Coll.

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Objective: Acanthosis Nigricans is characterized by skin thickening with hyperpigmentation dermatosis predominantly seen on flexural aspects & nape of neck. The objective of present study was to determine frequency of Acanthosis Nigricans among patients of type II diabetes mellitus. Study Design and Setting: This observational cross-sectional study was undertaken at Department of Medicine Azra Naheed Medical College, Superior University Lahore from August 2021 to April 2022. Methodology: Type II diabetes mellitus was defined as patients with HbA1c 7.0%, or two blood glucose random readings of =200mg/dl, or previous history of diabetes diagnosis, or taking anti-hyperglycemic medicines. Acanthosis Nigricans was defined as >2 cm poorly defined hyperpigmented skin lesions of brownish black color and velvety appearance present over the nape of neck, axillae and/or groin. Patients with non-diabetic causes of Acanthosis Nigricans were excluded. After informed consent, 340 patients of type II diabetes mellitus aged 30-75 years of both gender were enrolled using nonprobability consecutive sampling technique. Demographic information was noted and the patients were examined for Acanthosis Nigricans. Data was entered and analyzed by SPSS version 20.0. Results: Mean age was 48.2+13.8 years with 187 (55.0%) females. The mean height, weight and BMI were 1.5+0.3 meters, 57.8+11.6 kilograms and 28.8+9.5 kg/m2 respectively. The mean duration of disease was 44.2+9.3 months and Acanthosis Nigricans was seen in 86 (25.2%). Acanthosis Nigricans was not significantly associated with age, gender, BMI or duration of disease. Conclusion: Acanthosis Nigricans was present in almost a quarter of type II diabetes mellitus patients.

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Section: Resultsmentioning

confidence: 99%

Acanthosis Nigricans in Patients with Type II Diabetes Mellitus at a Tertiary Care Hospital of Lahore

Butt¹,

Mahmood²,

Kanwal³

et al. 2022

J. Bahria Uni. Med. Dent. Coll.

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“…Type B insulin resistance syndrome (TBIRS) is an extremely rare entity, with unknown prevalence. Only 116 cases have been described in the literature [2,4]. e first time this disease was described was in 1975 when six patients presented with overt insulin resistance with acanthosis nigricans and high insulin requirements due to a serumcirculating factor which affected insulin binding to its receptor [5].…”

Section: Discussionmentioning

confidence: 99%

Late Systemic Lupus Erythematosus-Associated Insulin Resistance Syndrome: A Rare Cause of De Novo Diabetes Mellitus

Álvarez-Payares

Ribero-Vargas

Rodríguez

et al. 2022

Case Reports in Medicine

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The association of type B insulin resistance syndrome (TBIRS) due to autoimmune diseases such as systemic lupus erythematosus (SLE) is uncommon. This is partly due to the lack of established criteria for the diagnosis of this resistance. However, some clinical aspects may suggest that the diagnosis does not necessarily have to be positive insulin receptor antibodies as such patients could respond to immunosuppressive treatment. Methods. We describe a case and have performed a literature review on PubMed/MEDLINE, EMBASE, and Google Scholar bibliographic databases to identify all case reports. All available studies from January 1975 through December 2020 were included. Data collected were tabulated, and outcomes were analyzed cumulatively. Results. Thirty-one cases of TBIRS associated with SLE have been described. These patients presented with catabolic symptoms and hyperglycemia in most cases, with an average time from the onset of symptoms of four months. In addition to that clinical characteristics related to SLE were variable, along with certain common characteristics such as acanthosis in 60% of patients. Almost all the patients had antibodies against insulin receptors. The insulin doses required by the patients ranged from 450 to 25,000 U daily. Remission was achieved in 80% of the patients with a two-year follow-up. Most patients associated with late-onset SLE, like our patient, achieved metabolic control after immunosuppressive treatment. Conclusion. High insulin resistance in patients with de novo diabetes mellitus (DM) without obesity should be considered as a possible clinical manifestation of an autoimmune disease such as SLE, with a good metabolic response to the immunosuppressive management established.

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Acanthosis Nigricans: An Updated Review

Leung

Lam

Barankin³

et al. 2023

CPR

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Background: Early recognition of acanthosis nigricans is important because acanthosis nigricans can be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. Objective: This purpose of this article is to familiarize pediatricians with the clinical manifestations, evaluation, diagnosis, and management of acanthosis nigricans. Methods: A search was conducted in November 2021 in PubMed Clinical Queries using the key term "acanthosis nigricans". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Results: Acanthosis nigricans is characterized by symmetric, hyperpigmented, velvety plaques with ill-defined borders, typically involving intertriginous areas. Obesity is the most common cause of acanthosis nigricans which is increasing observed in obese children and adolescents and can serve as a cutaneous marker of insulin resistance. Early recognition of acanthosis nigricans is important because acanthosis nigricans can also be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. The diagnosis is mainly clinical, based on the characteristic appearance (symmetrically distributed, hyperpigmented, velvety, papillomatous, hyperkeratotic plaques with ill-defined borders) and the typical sites (intertriginous areas, flexural area, and skin folds) of the lesions. Although acanthosis nigricans is treatable, complete cure is difficult to achieve. The underlying cause should be treated, if possible, to resolve and prevent recurrence of acanthosis nigricans. This may consist of weight reduction, discontinuation of causative drugs, treatment of underlying endocrinopathy, or treatment of an underlying malignancy. For patients with isolated acanthosis nigricans and for those whose underlying cause is not amenable to treatment, treatment of the lesion may be considered for cosmetic reasons. Topical retinoids, vitamin D analogs, chemical peels, and other keratolytics are often used for the treatment of localized lesions. Seldom, systemic therapy such as oral retinoids may be considered for extensive or generalized acanthosis nigricans and acanthosis nigricans unresponsive to topical therapy. Other uncommon treatment modalities include dermabrasion, laser therapy, and surgical removal. Conclusion: Although acanthosis nigricans is treatable, complete cure is difficult to achieve. The underlying cause should be treated, if possible, to resolve and prevent recurrence of acanthosis nigricans. The diagnosis is mainly clinical, based on the characteristic appearance (symmetrically distributed, hyperpigmented, velvety, papillomatous, hyperkeratotic plaques with ill-defined borders) and the typical sites (intertriginous areas, flexural area, and skin folds) of the lesions. The diagnosis might be difficult for lesions which have atypical morphology or are in an unusual location Due to the association between acanthosis nigricans and underlying pathologies, clinicians should be knowledgeable about the clinical manifestations, evaluation, diagnosis, and management of acanthosis nigricans.

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A Lean Lady With Acanthosis Nigricans and Uncontrolled Diabetes Mellitus

Cited by 3 publications

References 19 publications

Acanthosis Nigricans in Patients with Type II Diabetes Mellitus at a Tertiary Care Hospital of Lahore

Acanthosis Nigricans in Patients with Type II Diabetes Mellitus at a Tertiary Care Hospital of Lahore

Late Systemic Lupus Erythematosus-Associated Insulin Resistance Syndrome: A Rare Cause of De Novo Diabetes Mellitus

Acanthosis Nigricans: An Updated Review

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