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Variants of the melanocortin-4 receptor (MC4R) gene are the most common cause of monogenic obesity. In this situation; while obesity cannot be controlled with diet and exercise, it was shown that Glucagon-like-peptide-1 receptor agonists (GLP-1 RA) provide weight loss in short term. In this paper, we present our experience with Liraglutide treatment in an adolescent patient carrying MC4R gene variant. A female patient had admitted first at the age of 12.5 years with a complaint of progressive weight gain. She had a marked excess of appetite since infancy. In the physical examination of the pubertal female patient with a body mass index (BMI) of 36.1kg/m2 (3.48 SDS), there was no pathological finding except diffuse acanthosis nigricans. Laboratory examinations revealed only insulin resistance. Weight loss couldn't be achieved with lifestyle changes, metformin and orlistat treatments In genetic examination, a sporadic heterozygous c.206T>G(p.I69R) variant (reported previously) was found in the MC4R gene. GLP-1 RA Liraglutide treatment was initiated and a loss of 19.2% reduction was achieved in the patient's body weight and BMI at the end of 32 weeks. However, the patient, whose treatment compliance was disrupted due to significant gastrointestinal complaints, returned to her former weight within a few months after treatment was stopped. In our case carrying a pathogenic variant in the MC4R gene, decrease of appetite and weight loss were achieved with Liraglutide treatment, but this situation could not be maintained. In such cases, there is a need for effective and tolerable treatment options.

This narrative review aims to provide readers with a comprehensive overview of the current literature of acanthosis nigricans (AN) in the pediatric and adolescent population, including best practices for identifying the condition, with a focus on the recommended management in the primary care setting to enable early and enhanced intervention.AN is frequently seen in obese and overweight children and adolescents. Current research suggests an association with insulin resistance, type 2 diabetes mellitus, and obesity, and often primary care physicians are the first point of contact for individuals with this dermatologic condition. However, identifying the condition at an early stage may be difficult.We identified case and cross-sectional studies, clinical trials, and literature reviews of pediatric AN for ages 0 to 18 years in the United States and internationally. We considered publications for background from before the year 2000 and publications for approach to management from after the year 2000.AN in the pediatric population can be a harbinger for underlying metabolic syndrome and insulin resistance. A thorough investigation and appropriate screening of children at risk, with a focus on early identification of the dermatologic condition and its associated comorbidities in the primary care setting, and early treatment is recommended to prevent long term consequences and decrease the risk of cardiovascular complications.

Acanthosis Nigricans is considered to be a skin marker of insulin resistance and atherosclerosis. It is rarely reported in cases of insulinoma where there is marked hyperinsulinaemia. We report two cases of insulinoma with acanthosis nigricans which regressed, concomitant with significant weight loss and reduction in blood pressure following surgical resection. This strengthens the hypothesis that hyperinsulinaemia is responsible for Acanthosis nigricans and atherosclerotic risk factors.

Background: The impact that dietary carbohydrates have on children developing type 2 diabetes remains controversial. Furthermore, there are limited pediatric longitudinal studies on changes in body mass index (BMI) and diet related to the development of acanthosis nigricans (AN), a risk factor associated with type 2 diabetes. Methods: Two 24 h dietary records were collected for 558 children, 2–8 years of age, at baseline and at a 2-year follow-up. Data on age, sex, BMI, and the presence of AN were also collected at each time point from the Children’s Healthy Living Program. Logistic regression was used to determine factors associated with the presence of AN at follow-up. Multinominal regression was used to determine factors associated with changes in AN status. Linear regression was used to measure the associations between changes in dietary intake and in the Burke Score for AN. Results: AN was present in 28 children at baseline and 34 children at follow-up. Adjusting for the presence of AN at baseline, age, sex, study group, baseline BMI, change in BMI z-score, time between assessments, and baseline intake, an increase from baseline for each teaspoon of sugar and serving of carbohydrate-rich food increased the risk for having AN at follow-up by 9% and 8%, respectively (p ≤ 0.05). An increased intake of added sugar (teaspoons) increased the risk of developing AN by 13% (p ≤ 0.01) and an increase in servings of foods rich in starch increased the risk of developing AN by 12% (p ≤ 0.01) compared to children who never had AN. Increasing the intake of fruit was also associated with decreased Burke Scores using multiple regression. However, the intake of energy and macronutrients were not associated with AN. Conclusions: Added sugar and foods rich in starch were independently associated with the occurrence of AN, suggesting the type of carbohydrates consumed is a factor in AN occurrence.

Obese and overweight individuals may have a wide spectrum of cutaneous features and can have more severe manifestations of multiple dermatological conditions. There have been multiple expert opinions on the role of weight loss, in the improvement of skin conditions. There have been few studies over the past decade evaluating the effects of exercise and other modes of weight reduction on various dermatoses such as psoriasis, acne vulgaris, hidradenitis suppurativa and acanthosis nigricans. In this review, we have attempted to provide a summary of the beneficial effects of weight loss on various dermatological conditions.

Summary Oral papillary lesions represent a variety of developmental and neoplastic conditions. Early diagnoses of different papillary lesions are challenging for oral medicine specialists. Malignant acanthosis nigricans (MAN) is a rare cutaneous disorder and a potential marker of underlying hidden tumours. It is characterized by papillary lesions that always involve the oral mucosa. In oral medicine specialities, MAN is not well understood. When the early signs of MAN are extensive oral lesions and slight cutaneous pigmentation without obvious florid cutaneous papillomatosis, the diagnosis can be incorrect or delayed. Oral medicine specialists should ask affected patients to provide details of their medical history and conduct a timely systemic examination.

Acanthosis nigricans (AN) is a common dermatosis that presents with hyperpigmented, velvety thick plaques over intertriginous areas. Though a number of treatment modalities including chemical peels have been used, none provide long-term and sustained improvement.Our study evaluated the efficacy and safety of regular sessions of salicylic acid-mandelic acid peeling over axillary AN lesions, which was followed by daily application of a topical combination of glycolic acid, urea, and cetylated fat esters for maintenance of effect for 9 months.A retrospective pilot study was conducted in Indian patients (Fitzpatrick skin type 4 or 5), aged 18-50 with benign hereditary AN involving the underarms, with or without affection of other typical sites. Data were retrieved of seventeen patients with AN involving the axillae. Patients were started on combination salicylic-mandelic acid peel given every 2 weeks for a total of 6 sessions. Maintenance was done by night application of combination cream of glycolic acid, urea, and cetylated fat esters, which was continued for 9 months after completion of peeling sessions. Lesions were evaluated every 3 months of 9 months for improvement in pigmentation and skin thickening.All the patients (100%) showed significant improvement in both pigmentation and thickening of lesions. In terms of improvement in skin thickening, very good improvement was seen in 41%, while 29% patients had moderate improvement. In terms of improvement in pigmentation, 35% each had very good and moderate improvement. Post peel erythema (100%) and burning sensation (90%) were the most common encountered adverse effects which lasted for only 1-2 days. Patients were followed up for another 9 months during which no relapses were seen.Combination of keratolytic chemical peels and topical mild keratolytic application ensures better therapeutic outcome in patients of AN with long lasting effect.

Background The prevalence of community-based skin diseases, especially among school-age children, depends on topography, climate, and age of population. Objective We determined the prevalence of skin diseases among community-based primary school-age children and identified demographic characteristics in relation to particular skin conditions. Methods This was a cross-sectional descriptive survey study of a subproject school cohort in children aged 5–14 years of 2 community-based primary schools. Demographic data and whole-body skin examination were collected. The association of individual skin conditions was analysed by using bivariate and multivariable binary logistic regression. Results A total of 556 children were enrolled in this study. Of these, 90.2% had at least 1 skin disease. The most common skin disease was postinflammatory hyperpigmentation (PIH) (58.3%), followed by nevus/mole (40.1%), insect bite reaction (28.0%), acanthosis nigricans (20.0%), acne (13.7%), and pityriasis alba (12.9%). There was an increase of body mass index (BMI) in PIH and acanthosis nigricans with the adjusted odds ratios of 2.01 (95% confidence interval [CI] 1.40–2.87, P < 0.001) and 1.93 (95% CI 1.49–2.49, P < 0.001), respectively. Insect bite reaction was related to PIH with the adjusted odds ratio of 5.66 (95% CI 3.15–10.17, P = 0.001). Conclusions The most common skin disease in community-based primary school-age children is PIH which related to acanthosis nigricans and insect bite reaction. A decrease of BMI may lower the risk for PIH and acanthosis nigricans. Education on common skin diseases is recommended for both community-based schools and school-age children.

Chronic acral hyperkeratotic dermatosis includes several conditions such as lichen simplex chronicus (LSC), hypertrophic lichen planus (HLP), psoriasis vulgaris (Ps), acral acanthosis nigricans, acquired zinc deficiency, and necrolytic acral erythema (NAE). LSC, Ps, and HLP respond to conventional treatments such as topical corticosteroids, immuno-modulators such as tacrolimus, and oral methotrexate. Zinc-responsive acral hyperkeratosis is a novel entity that resembles the above mentioned diagnoses clinically but fails to respond to the above treatment options. NAE is a rare condition, commonly associated with hepatitis C virus infection and manifest similar clinical features of zinc-responsive acral hyperkeratosis, but differs histopathologically. Both conditions show a good response to oral zinc supplementation. As there is a paucity of literature on zinc-responsive acral hyperkeratosis, we are highlighting the case.

BACKGROUND Acanthosis nigricans is commonly associated with obesity. It is characterized by brown-black skin thickening on the neck and the flexural areas. This study aimed to assess the efficacy of topical 20% urea cream compared to 10% urea cream in the treatment of acanthosis nigricans in adolescents. MATERIAL AND METHODS A randomized comparative, double-blind study was conducted on participants aged 12-18 years with acanthosis nigricans of the neck. Treatment efficacy was assessed via narrowband reflectance spectrophotometer, while the overall success rates at weeks 2, 4, and 8 were evaluated by the investigator- and participant-assessed global evaluation scales. RESULTS A total of 40 participants with acanthosis nigricans were enrolled and completed the study. Throughout the period of 8 weeks of treatment, 20% urea showed greater improvement of hyperpigmentation compared to 10% urea (p = 0.001), with 22.5 ± 11.9% and 10.7 ± 8.1% improvements, respectively. Findings from the overall global evaluation scales were consistent with the results from the narrowband reflectance spectrophotometer. Treatment with 10% urea and 20% urea was well-tolerated without any local serious adverse reactions. CONCLUSION Urea cream improves neck hyperpigmentation associated with acanthosis nigricans in adolescents, in which the 20% concentration shows superior efficacy to the 10% concentration.

OBJECTIVE Crouzon syndrome with acanthosis nigricans (CAN) is a rare and clinically complex subtype of Crouzon syndrome. At three craniofacial centers, this multicenter study was undertaken to assess clinical signs in relation to the required interventions and treatment course in patients with CAN. METHODS A retrospective cohort study of CAN was performed to obtain information about the clinical treatment course of these patients. Three centers participated: Erasmus Medical Centre, Rotterdam, the Netherlands; John Radcliffe Hospital, Oxford, United Kingdom; and Hôpital Necker-Enfants Malades, Paris, France. RESULTS Nineteen patients (5 males, 14 females) were included in the study. All children were operated on, with a mean of 2.2 surgeries per patient (range 1–6). Overall, the following procedures were performed: 23 vault expansions, 10 monobloc corrections, 6 midface surgeries, 11 foramen magnum decompressions, 29 CSF-diverting surgeries, 23 shunt-related interventions, and 6 endoscopic third ventriculostomies, 3 of which subsequently required a shunt. CONCLUSIONS This study demonstrates that patients with the mutation c.1172C>A (p.Ala391Glu) in the FGFR3 gene have a severe disease trajectory, requiring multiple surgical procedures. The timing and order of interventions have changed among patients and centers. It was not possible to differentiate the effect of a more severe clinical presentation from the effect of treatment order on outcome.

Qatar has a high obesity and type 2 diabetes mellitus (T2DM) burden. This study aimed to (1) determine the prevalence of overweight, obesity, and T2DM in 13–17-year-old adolescents and (2) evaluate associations with adolescents’ lifestyle and breastfeeding history, parental weight, and familial T2DM history. A cross-sectional study (double-stage cluster sampling) was conducted in 2018–2020 using a self-administered parental and adolescent questionnaire. In the results, 23.4% of the adolescents (107/459) were overweight; 19.9% (91/459) were obese; and 37.6% (171/459) had evidence of central obesity. Random blood sugar (RBS) was suggestive of prediabetes (≥140 mg/dL) for 23 (5.0%) adolescents and T2DM (≥200 mg/dL) for none. In multivariable analysis, obesity was significantly associated with no breastfeeding (OR = 3.17, 95% CI: 1.09–9.26) compared to breastfed adolescents for ≥6 months, with first-degree family history of T2DM (OR = 2.27; 95% CI: 1.22–4.27), with maternal obesity (OR = 2.40; 95% CI: 1.01–5.70), and with acanthosis nigricans in adolescents (OR = 19.8; 95% CI: 8.38–46.9). Central obesity was significantly associated with maternal obesity (OR = 2.21; 95% CI: 1.14–4.27) and with acanthosis nigricans (OR = 3.67; 95% CI: 1.88–7.18). Acanthosis nigricans (OR = 4.06; 95% CI: 1.41–11.7) was the only factor associated with elevated RBS. Addressing future disease burden among adults in Qatar will require extensive health and well-being programs, focused on healthy lifestyles and behaviors such as nutritious diets, physical activity, stress management, and self-care.

Traballo Fin de Grao en Medicina. Curso 2021-2022 Introdución e obxectivos: A síndrome de Rabson-Mendenhall encádrase dentro das síndromes de resistencia á insulina extremas e é causado por variantes bialélicas no xene do receptor da insulina. Unha das súas características clínicas é a presenza de acantose nigricans. A literatura máis actual considera que a acantose nigricans relacionada coa resistencia á insulina pode explicarse pola acción da insulina sobre o receptor de IGF-1. Este traballo ten como obxectivo entender cales son os mecanismos moleculares que levan á aparición de acantose mediante o cultivo de fibroblastos e preadipocitos primarios de pacientes con síndrome de Rabson-Mendenhall. Material e métodos: Cultivo de dúas liñas celulares de pacientes afectados pola síndrome de Rabson-Mendenhall (fibroblastos e preadipocitos) e de fibroblastos de individuo san, que actuarán como control. Trataranse con insulina, insulina e un inhibidor de IGF-1R (Linsitinib) e insulina e un inhibidor de GSK-3b (CHIR99021), cos seus controis respectivos con DMSO. Posteriormente extraerase cDNA para avaliar a expresión xénica mediante RT-qPCR. Resultados e conclusións: Avaliouse a expresión dos seguintes xenes: MAP3K5, MAP2K1, PI3KR1, ELK1, CTNNB1, MTOR, CCNC, GSK3B mediante RT-qPCR. Os resultados amosan unha tendencia ao aumento de expresión nas liñas celulares afectadas, estatisticamente significativo nalgúns dos xenes. Tras o tratamento con Linsitinib, evidénciase en certos xenes unha tendencia á baixa na expresión. Respecto a CHIR99021, a tendencia é ao aumento na expresión, se ben non xeneralizado nos xenes a estudo. Obsérvase un aumento de expresión significativo nos xenes da ruta MAPK na liña celular de fibroblastos de Rabson-Mendenhall, o que indicaría que esta vía está involucrada no desenvolvemento de AN. Obxectívase polo tanto que parece plausible pensar que a AN nos síndromes de resistencia á insulina se relaciona con IGF-1R, mais fanse necesarios máis estudos que determinen o alcance destes achados Introducción y objetivos: El síndrome de Rabson-Mendenhall se encuadra dentro de los síndromes de resistencia a la insulina extremos y es causado por variantes bialélicas en el gen del receptor de insulina. Una de sus características clínicas es la presencia de acantosis nigricans. La literatura más actual considera que la acantosis nigricans relacionada con la resistencia a la insulina se puede explicar por la acción de la insulina sobre el receptor de IGF-1. Este trabajo tiene como objetivo entender cuáles son los mecanismos moleculares que llevan a la aparición de acantosis mediante el cultivo de fibroblastos y preadipocitos primarios de pacientes con síndrome de Rabson-Mendenhall. Material y métodos: Cultivo de dos líneas celulares de pacientes afectados por el síndrome de Rabson-Mendenhall (fibroblastos y preadipocitos) y de fibroblastos de individuo sano, que actuarán como control. Se tratarán con insulina, insulina y un inhibidor de IGF-1R (Linsitinib) e insulina y un inhibidor de GSK-3b (CHIR99021), con sus controles respectivos de DMSO. Posteriormente se extraerá cDNA para evaluar la expresión génica mediante RT-qPCR. Resultados y conclusiones: Se evaluó la expresión génica de los siguientes genes: MAP3K5, MAP2K1, PI3KR1, ELK1, CTNNB1, MTOR, CCNC, GSK3B mediante RTqPCR. Los resultados muestran una tendencia al aumento de expresión en las líneas celulares afectadas, estadísticamente significativo en algunos de los genes. Tras el tratamiento con Linsitinib, se evidencia en ciertos genes una tendencia a la baja en la expresión. Respecto a CHIR99021, la tendencia es al aumento en la expresión, si bien no generalizado en los genes a estudio. Se observa un aumento de expresión significativo en los genes de la ruta MAPK en la línea celular de fibroblastos de Rabson-Mendenhall, lo que indicaría que esta vía está involucrada en el desarrollo de AN. Se objetiva por lo tanto que parece plausible pensar que la AN en los síndromes de resistencia a la insulina se relaciona con IGF-1R, aunque se hacen necesarios más estudios que determinen el alcance de estos hallazgos Introduction and objectives: Rabson-Mendenhall syndrome is set within extreme insulin resistance syndromes, and it is produced by biallelic variants in insulin receptor gene. One typical clinical characteristic is the presence of acanthosis nigricans. Now it is considered that acanthosis nigricans due to insulin resistance would be explained by the action of insulin in IGF-1 receptor. The objective of this project is showing what are the molecular mechanisms involved in the acanthosis through culturing fibroblasts and primitive preadipocytes of Rabson-Mendenhall syndrome patients. Material and methods: culture of two patients cell lines affected by Rabson-Mendenhall syndrome (fibroblasts and preadipocytes) and culture of fibroblasts from a healthy individual, which will act as a control. Cells will be treated with insulin, insulin and IGF-1R inhibitor (Linsitinib) and insulin and GSK-3b inhibitor (CHIR99021). Respective controls with DMSO were established. Then, cDNA will be extracted to evaluate genetic expression through RT-qPCR. Results and conclusions: Gene expression of the following genes (MAP3K5, MAP2K1, PI3KR1, ELK1, CTNNB1, MTOR, CCNC, GSK3B) was evaluated by RTqPCR. Results tend to increase expression in the affected cell lines, statistically significant in certain genes studied. After Linsitinib treatment, gene expression tends to decrease in some genes. After CHIR99021 treatment, gene expression tends to increase, though it is not generalized in all genes. It is shown a statistically significant increase in MAPK pathway genes in fibroblasts of Rabson-Mendenhall cell line, which would indicate that this pathway in involved in the development of AN. Therefore, it is objectified that AN in insulin-resistance syndromes is related with IGF-1R, although more studies are needed to determine the impact of these findings

Acanthosis nigricans (AN) е рядко вродено или придобито вторично кожно заболяване, характеризиращо се с потъмняване (хиперпигментация) и удебеляване (хиперкератоза) на кожата. Ангажирани са симетрично гънките: в подмишницата (аксилата), слабините и задната част на врата. Подразделя се на доброкачествен („pseudoacanthosis nigricans“) и злокачествен AN. Представя се случай на 43-годишна жена с AN – симетрични пигментирани плаки с папиломатозна повърхност в аксилите, тила, гърба на ходилата, на фона на клинични прояви на обезитас IІІ степен (ИТМ > 40 кг/м2) и инсулинорезистентен диабет с над 10-годишна давност. Изключени са хипотиреоидизъм, акромегалия, овариална поликистоза и болест на Кушинг. Направен е скрининг за висцерална неоплазия. Фамилната анкета не открива изява на AN сред близките. AN най-вероятно се причинява от фактори, които стимулират пролиферацията на кератиноцитите в епидермиса и на фибробластите в дермата. При доброкачествената форма на AN, такъв фактор вероятно е инсулинът или инсулиноподобният растежен фактор (IGF), който стимулира растежа на епидермалните клетки. Определена роля играят и рецепторите на тирозин киназата (рецептора на епидермален растежен фактор или рецептора на растежен фактор на фибробластите). При високи концентрации, инсулинът упражнява мощен пролиферативен ефект, чрез свързване с висок афинитет към IGF-1 рецепторите. В допълнение, нивата на свободен IGF-1 могат да бъдат повишени при пациенти със затлъстяване с хиперинсулинемия, което води до ускорен клетъчен растеж и диференциация. Представеният случай е илюстративен за рядка дерматоза, която може да бъде вродена или паранеопластичен дермадром.

Objectives Monogenic diabetes mellitus (DM) is a single gene disorder, primarily characterized by impairment in the development or function of pancreatic beta cells. Case presentation A 14-year-old girl was initially diagnosed with type 2 DM. The patient did not have any anti-islet autoantibody and showed acanthosis nigricans. She was managed with long-acting insulin and oral hypoglycemic agent, but HbA1c was still 9.3% after 1 year of management. Her mother already had type 2 DM at 46-year-old and was on medication. Under the possibility of familial monogenic DM, targeted exome sequencing was performed which included 29 genes associated with monogenic DM. Nonsense mutation of the gene RFX6 (c.2661T>A, p.Tyr887∗) was found. After adding Glucagon-like peptide-1 (GLP-1) receptor agonist, HbA1c improved from 8.8 to 6.8% and body mass index (BMI) also improved from 31.0 to 29.2 kg/m2. Conclusions It may be worth investigating genetic etiology in early-onset autoantibody-negative DM for specific genetic diagnosis and better management.

Endocrine diseases such as obesity, diabetes mellitus, Cushings syndrome, hypothyroidism and hyperthyroidism, acromegaly and hyperandrogenism in children and adolescents are often manifested by changes in the skin. Moreover, skin symptoms can be a marker of systemic, in this case, endocrine and metabolic diseases. Obesity and diabetes are chronic diseases that affect people all over the world, and their incidence is increasing in both children and adults. Clinically, they affect a number of organs, including the skin. The cutaneous manifestations caused or aggravated by obesity and diabetes are varied and usually bear some relation to the time that has elapsed since the onset of the disease. They include acrochordons, acanthosis nigricans, striae, xerosis, keratosis pilaris, plantar hyperkeratosis, fungal and bacterial skin infections, granuloma annulare, necrobiosis lipoidica. In obese patients, psoriasis and atopic dermatitis are more common than in the control group. With the pathology of the thyroid gland, diseases such as alopecia, pretibial myxedema, urticaria, and some others develop. Hyperandrogenism (polycystic ovary syndrome) is accompanied by skin lesions such as acne vulgaris, hirsutism, androgenic alopecia, acanthosis nigricans. This literature review focuses on the main skin syndromes accompanying endocrine pathology in children and adolescents. Information about such clinical associations can make it easier for pediatricians and endocrinologists to diagnose and treat endocrine diseases in a timely manner and, thereby, prevent long-term adverse consequences.

BACKGROUND Linear lesions are fairly common in our daily practice. However, the appearance of these lesions can vary, thus complicating the diagnosis. AIMS To study the various clinical presentations, the demographic profile of patients and the clinicopathological correlations of dermatoses presenting with a linear distribution. METHODS We conducted an institution-based, cross-sectional, descriptive study of 281 consecutive patients with linear lesions attending dermatology clinics. MedCalc software (V11.6) was used for statistical analysis. RESULTS Patients were divided into eight groups: lesions along the lines of Blaschko (n = 136), lesions along blood vessels (n = 3), lesions along lymphatics (n = 3), Koebner phenomenon (n = 24), autoinoculation (n = 24), external factors (n = 45), infestations (n = 2) and 'other' (n = 44). The mean age at presentation was 24.50 ± 18.82 years and the male/female ratio was 1.32 : 1. The commonest symptom was itching/burning (56.94% of patients), while the commonest site was the arm (44.48%); followed by the leg (30.60%), trunk and abdomen (22.42%), head and neck (19.20%), and genitalia (0.35%). Apart from the common cases, there was a wide gamut of rare conditions (e.g. angiokeratoma circumscriptum naeviforme, porokeratotic eccrine ostial and dermal duct naevus, Blaschko-linear syringocystadenoma papilliferum, progressive cribriform and zosteriform hyperpigmentation, unilateral naevoid acanthosis nigricans, fixed drug eruption, discoid lupus erythematosus). CONCLUSION Linear lesions act as diagnostic clues to many dermatological conditions, therefore, the importance of meticulous examination in clinical dermatology cannot be overemphasized.

The diagnosis of Verruca Vulgaris is usually clinically, but, in certain situations, confirmation of the diagnosis with biopsy is needed. Several dermatological conditions share microscopic features with Verruca Vulgaris; however, the combination of history, dermatological examination, and histological description would confirm the diagnosis. The purpose of this study is to describe pathological conditions that share histological characteristics with verruca Vulgaris. A systematic review of the literature was used in this study. The histological differential diagnosis of verruca Vulgaris was divided into two categories. First, dermatological conditions that characterized by the presence of vacuolated cells; these conditions are Bowen’s Disease and Epidermodysplasia Verruciformis. Second, dermatological conditions that show papillomatosis which includes Verrucous Epidermal Nevus, Hyperkeratotic Seborrheic keratosis, and Acanthosis Nigricans Verruciform xanthoma, Confluent and reticulated papillomatosis.

Diabetes mellitus is a significant worldwide health concern and cutaneous manifestations are common. This review describes characteristic skin findings of diabetes, general skin findings related to diabetes, and findings related to diabetes treatment with a focus on clinical presentation, diagnosis, pathophysiology, epidemiology, and treatment. As the prevalence of diabetes continues to rise, cutaneous manifestations of diabetes mellitus likely will be encountered more frequently by physicians in all disciplines including dermatologists and primary care physicians. Accordingly, knowledge regarding the prevention, diagnosis, and management of cutaneous manifestations is an important aspect in the care of patients with diabetes.

Introducción: el síndrome metabólico es un conjunto de anormalidades fisiológicas que manifiestan resistencia a la insulina, de la que se derivan complicaciones micro y macrovasculares de alto costo en salud. Objetivo: Estimar la prevalencia de Acantosis Nigricans (AN) y los factores sociodemográficos asociados a la población con síndrome metabólico del municipio de Nobsa (Boyacá) en el periodo de agosto de 2017 a agosto de 2018. Método: estudio transversal analítico en una muestra de 82 pacientes del programa de crónicos del municipio de Nobsa. Se recolectó información sobre la presencia o ausencia de Acantosis Nigricans en la exploración física junto a medidas antropométricas, fototipo de piel y presión arterial; así como concentración sérica de glucosa en ayuno creatinina y perfil lipídico. Los datos fueron analizados mediante la prueba de Chi cuadrado. Resultados: En una muestra de 82 pacientes con edad media de 62 años, de los cuales el 91% fueron mujeres; Se encontró una prevalencia de Acantosis Nigricans del 41.5% con asociación estadísticamente significativa para niveles elevados de glucosa (p de 0.008) y un Odds Ratio de 3.75 (IC95% 1.3-10.2) para las demás variables en estudio no se evidencio asociación con significancia estadística Conclusiones: la Acantosis Nigricans es un signo clínico indicador de resistencia a la insulina y de niveles alterados de glucemia.

Background and objectives:Acanthosis nigricans (AN) is a major cosmetic and pathological condition associated with obesity,hirsutism, polycystic ovary, DM, metabolic syndrome and insulin resistance. This study was conducted to determine frequency of obesity in acanthosis nigricans and the association of BMI and central obesity with gender, age andtype of AN. Methodology: This hospital based observational study was conducted from1st March to 31st May 2021 at department of Medicine RIHS Islamabad after ethical approval. Sample size was calculated to be 221.Inclusion criteria: Adult cases of both the genders presenting with AN in medical OPD. Exclusion criteria:Diagnosed cases of malignancy, critically ill cases, endocrine disorders and pregnant women were excluded.After detailed history and examination, clinical diagnosis of Acanthosis nigricanswasmade. The weight in kg and height in meters measured and BMI calculatedby formula weigh in Kg/height (m2).Waist circumference measured in cm by flexible measuring tape from narrowest part of torso,midway between the lowest rib and iliac crest for central obesity and relevant investigations suggested. Data analyzed by SPSS version 21.Chi-square test was used to compare various variables between obese and non-obese AN cases with significant p0.05).Diabetes mellitus observed in 47 (21%) AN cases.Polycystic ovaries (PCOs) in 111 out of 152 females with AN. Autoimmune conditions seen in 53(24%) AN cases. Conclusion: Benign and HAIR-AN were most frequent type in our study that was associated with raised BMI, waist circumference, PCOS and diabetes. It is recommended to screen acanthosis nigricans cases regardless of age or gender for obesity, PCOS, DM, hypertension and autoimmune conditions. Hence,early diagnosis may improve quality of life, prevent complications of systemic disease and improve outcome of diseases and quality of life of patients.

Crouzon syndrome is one of the most common craniosynostosis facial syndromes caused by a mutation in the fibroblast growth factor receptor 2 (FGFR2) gene. Less commonly, there is a mutation of the FGFR3 gene which results in Crouzon syndrome syndrome with acanthosis nigricans. It involves the premature fusion of sutures of the cranial vault, base, orbital and maxillary region. The clinical presentation of this congenital deformity depends on the pattern and timing of sutural fusion. The present report describes the features and management of this syndrome in an 18-year-old woman. The patient presented with a hypoplastic maxilla, deficient midface, exorbitism due to shallow orbits, severe crowding and bilateral crossbite. A multidisciplinary approach involving orthodontics and surgical intervention with distraction osteogenesis brought about marked improvement in the facial profile, occlusion and upper airway. The aesthetics and function were greatly enhanced, and the results were found to be stable at the end of three years.

Background Cardiovascular disease (CVD) risk assessment of children typically includes evaluating multiple CVD risk factors some of which tend to correlate each other. However, in older children and young adolescents, there are little data on the level of independence of CVD risk factors. The purpose of this study was to examine the relationships among various CVD risk factors to determine the level of independence of each risk factor in a sample of 5th-grade public school students. Method A cross-sectional analysis of 1525 children (856 girls and 669 boys; age: 9-12 years) who participated in baseline CVD risk assessment for the (S)Partners for Heart Health program from 2010 - 2018. Thirteen CVD risk factor variables were used in the analysis and included blood lipids [low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), and triglycerides], resting systolic and diastolic blood pressure (BP); anthropometrics [height, weight, body mass index (BMI), % body fat, waist circumference (WC)]. Additionally, acanthosis nigricans (a marker insulin resistance and diabetes), and cardiorespiratory fitness (VO2 ml/kg) was estimated using the PACER. Descriptive statistics, bivariate Pearson correlations, and principal component analysis were used to determine the relationships among these variables and the independence. Results Parallel analysis indicated two components should be extracted. Among the two components extracted, WC, % body fat, and BMI loaded highest on component 1, which explained 34% of the total variance. Systolic BP and diastolic BP loaded predominantly on component 2 and accounted for 17% of the variance. Cardiorespiratory fitness, acanthosis nigricans, HDL, and triglycerides loaded highest on the first component (loadings between 0.42 and 0.57) but still suggest some non-shared variance with this component. Low-density lipoprotein had low loadings on each component. Factor loadings were stable across sex. Conclusion Among the various CVD risk indicators, measures of adiposity loaded highest on the component that explained the largest proportion of variability in the data reinforcing the importance of assessing adiposity in CVD risk assessment. In addition, blood pressure loaded highest on the second component, suggesting their relative independence when assessing CVD risk. The data also provide support and rationale for determining what CVD risk factors to include- based on resource needs. For example, researchers or public health programs may choose to assess WC instead of lipid profile for cardiovascular related problems if ease of assessment and cost are considerations.

Acanthosis nigricans (AN) refers to the velvety, black hyperpigmentation in flexures usually on the neck and axillae. AN is associated with multiple endocrinopathies and insulin resistance is reported to be a common denominator among them. The aim of the study was to identify the correlation of metabolic factors (Serum glucose, lipid profile), endocrine factors (TSH, serum insulin), and nutritional factors (vitamin B12, Ferritin) in AN patients in Aravalli district of Gujarat state. A total of Seventeen Patients (11 male and 6 female) were included in the study History, clinical observations, physical parameters, and biochemical tests were noted in AN patients and correlation of some likely factors with AN was explored. The age was 28.41±15.09 years for AN group and 35.45±8.74 years for control group. The mean BMI was found to be higher in AN at 1 % level of significance (P = 0.007) implying that overweight/obesity is associated with AN. The mean TSH value was found to be higher in AN than control group at 5 % level of significance (P = 0.0115) implying that hypothyroidism (elevated TSH value) is associated with AN. The 45.45 % patients had higher blood glucose levels and some of the patients had higher level of insulin. The mean lipid profile, vitamin B12 and serum ferritin were found to be at non-significance level. All statistical tests were performed using graph pad prism software (version 5.0). Positive correlations were observed between higher fasting glucose and hyperinsulinemia with AN and others factors such as metabolic and endocrine like overweight/obesity, hypothyroidism, higher glucose and serum insulin with AN. This implies that AN can serve as a marker for detecting hyperinsulinemia and hypothyroidism. Some of the parameters like, Serum lipid profile, vitamin B12 and ferritin levels could not be correlated to AN. Thus, patients with AN can be targeted for lifestyle and behavioral modifications at an early stage to avoid the serious consequences of AN.

SUMMARY OBJECTIVE: This study aimed to describe the prevalence of acanthosis nigricans and high blood pressure in children and adolescents from low-income families, and to verify the association of elevated blood pressure with nutritional status and the presence of acanthosis nigricans. METHODS: This is a cross-sectional and controlled study with 232 children and adolescents from an institution for low-income families. Pubertal stage, body mass index Z-score, waist-to-height circumference ratio (increased waist-to-height circumference ratio >0.5), the presence of acanthosis nigricans, and blood pressure were assessed. RESULTS: The prevalence of excess weight and the change in waist-to-height circumference ratio was 37.9%. Acanthosis nigricans and increased blood pressure occurred in 20.3 and 34.8%, respectively. The prevalence of acanthosis nigricans and hypertension was higher in individuals with excess weight (p

A 22-year-old female has complained of hirsutism, acanthosis nigricans, enlarged clitoris, and menstrual disorders since puberty. Laboratory examinations revealed hyperandrogenemia. Severe insulin resistance and diabetes were found during hospitalization in our hospital. She was diagnosed with type A insulin resistance syndrome finally. After treatment with metformin, the acanthosis nigricans was significantly relieved, blood glucose was controlled satisfactorily, and the menstrual cycle was restored.患者女性，22岁。自青春期起逐渐出现多毛、黑棘皮征、阴蒂增大及月经紊乱等临床表现。曾多次查雄激素水平明显升高。我院住院期间发现存在严重胰岛素抵抗、糖尿病。胰岛素受体基因检测提示存在致病性突变，诊断为A型胰岛素抵抗综合征。予二甲双胍治疗后患者黑棘皮征有明显缓解，血糖控制满意，月经周期恢复。.

Few obesity prevention trials among children have demonstrated sustainable outcomes in the long term.To sustain a community-wide decrease in the prevalence of overweight and obesity among young children in the US-affiliated Pacific region.In the Children's Healthy Living community-randomized clinical trial, hierarchical modeling comparing the change in intervention and control communities accounted for community randomization (community clustering with jurisdictions), and adjusted for the age and sex distribution of the assessed children in a cross-sectional design. The outcome measures were repeated in communities rather than among individual children. A total of 27 communities in 5 jurisdictions (Hawai'i, Alaska, Commonwealth of the Northern Mariana Islands, American Samoa, and Guam) of the US-affiliated Pacific region were included. Participants included children aged 2 to 8 years in the 27 selected communities from October 1, 2012 (4329 in time 1 [baseline]) to August 31, 2015 (4043 in time 2 [intervention end]) and from January 1, 2019, to April 30, 2020 (1469 in time 3 [maintenance period]). Study analysis was completed March 25, 2022.Nineteen activities addressed training, policies, systems, and environments of communities and 6 target behaviors of children (consumption of fruit and vegetables, water, and sugar-sweetened beverages; sleep; physical activity; and screen time) during a 2-year intervention period. Continued partnership with community coalitions, ongoing academic training of community partners, and use of trial data during a 6-year maintenance period.The primary outcome was measured anthropometry; secondary outcomes were the presence of acanthosis nigricans, dietary intake derived from 2 days of food records, and survey questions on screen time and sleep disturbance.Among the 9840 children included in the analysis (4866 girls [49.5%] and 4974 boys [50.5%]; 6334 [64.4%] aged 2-5 years), the intervention group showed significant improvements compared with the control group from times 1 to 3 in prevalence of overweight plus obesity (d = -12.60% [95% CI, -20.92% to -4.28%]), waist circumference (d = -1.64 [95% CI, -2.87 to -0.41] cm), and acanthosis nigricans prevalence (d = -3.55% [95% CI, -6.17% to -0.92%]). Significant improvements were also observed from times 2 to 3 in prevalence of overweight plus obesity (d = -8.73% [95% CI, -15.86% to -1.60%]) but not in waist circumference (d = -0.81 [95% CI, -1.85 to 0.23] cm).This randomized clinical trial found that the outcomes of the Children's Healthy Living intervention were maintained and enhanced 6 years after the intervention among young children in the US-affiliated Pacific region. The prevalence of overweight, obesity, and acanthosis nigricans was further reduced in communities, suggesting that multilevel multicomponent interventions may help reduce child overweight and obesity in this region.ClinicalTrials.gov Identifier: NCT01881373.

Background: Acanthosis nigricans (AN) is a skin condition that presents clinically with hyperpigmented, hyperkeratotic, and velvety skin changes, especially in the intertriginous areas. The intertriginous areas are also susceptible to superficial cutaneous fungal infections. The potential relationship between AN and cutaneous fungal infection has not been investigated. Objective: The aim of this study was to determine the relationship, if any, between AN and fungal infection, both clinically and pathologically. Methods: A retrospective review was performed using electronic medical records and histology of biopsy slides obtained from 29 patients who were diagnosed with AN by two dermatopathologists. Comparison was made between the clinical and pathological findings of AN with fungal infection (ANFI+) and AN without fungal infection (ANFI-). Results: Among the 29 patients with AN, fungal spores were detected on the biopsy slides of 18 patients (62.1%) and appeared in the epidermal furrow more often than in the epidermal ridge. No significant clinical difference was found between the ANFI+ and ANFI- groups; however, in the ANFI+ group, lesions were more prevalent in the neck area (p = 0.048). In addition, the ANFI+ biopsy slides revealed more papillomatosis than ANFI- biopsy slides (p = 0.006). Conclusion: Fungal infection tends to appear in combination with AN when more severe papillomatosis is also present.

Describe growth at different periods of life to understand the effects of genetic impairment in FGFR3-related conditions. We hope this data will be used to compare different populations and the effects of future treatments towards growth improvement. The FGFR3 plays a critical role in early mammalian skeletal development, especially in postembryonic linear bone growth; however, little is known about its role during all of the growth process stages. In the achondroplasia growth curve, infancy, childhood, and puberty periods can be well recognized, coexisting with fast changes in body proportions. FGFR3 gain-of-function mutations are responsible for autosomal dominant chondrodysplasias characterized by a severe disproportionate short stature, as thanatophoric dysplasia, severe achondroplasia with developmental delay and acanthosis nigricans, achondroplasia, and hypochondroplasia. While achondroplasia is homogeneous with low variability, hypochondroplasia findings are less constant due to genotypic heterogeneity. In both conditions, birth size is slightly reduced, followed by a period of fast growth deceleration during infancy and a low magnitude pubertal growth spurt, most evident in sitting height. Some phenomena as shifting centile lines during infancy and parent-child height correlation are well described. A slight variability is shown between achondroplasia and hypochondroplasia populations within different ethnic backgrounds.

Introduction: Hirsutism is in fact unwanted growth of hairs on the various parts of body of females. Hairs arises particularly on those parts of the body on which hairs are not grown normally in females such as chin, upper lips, abdomen, legs, shoulder and back of the body. Various reasons are reported till so far for the hirsutism development. The prevalence of hirsutism was very low. Methodology: Across-sectional study was conducted at tertiary care hospital of Sindh, Pakisan for the period of 06 months. A well structured questionnaire was developed comprises on three parts. Which was given to the female students and all the participants were guided regarding filling of that proforma and Ferriman-Gallway scale was used to measure the frequency parameters of Hirsutism. Results: The condition of hirsutism was found among 183 participants, the distribution of hairs was quite different in all selected study subjects. 26 females had hairs on chin, 154 females had hair grown on upper lips, 24 females had hairs on lower abdomen, 13 had hairs on upper abdomen, 11 participants had hairs on arms and legs whereas only 04 girls had hair grown on their shoulders and back of the body. As far as their family background is concern 41 females were belongs to upper class, 117 females belongs to middle class while 25 females were belonging to lower class families. Conclusion: The prevalence of hirsutism was very much common among the females with the associated condition of Idiopathic hirsutism (53%), pulmonary chronic obstructive diseases (31.5%) and Acanthosis nigricans was the most widely recognized cutaneous finding related with hirsutism.

Objective: To present only skin lesions in the abdominal wall that we detected in morbidly obese patients and to examine them in the light of the literature. Material and Method: Patients who applied to the general surgery outpatient clinic for bariatric surgery and who also had dermatological complaints and were referred to the dermatology outpatient clinic with the detection of skin-related complaints were retrospectively evaluated in terms of age and breast skin findings. Normal skin findings were separated into intertrigo, chronic recurrent folliculitis, eczemas, acanthosis nigricans and striae. Results: A total of 60 obese female patients were included in the study. The mean age of the patients was 32.4 ± 8.8 years (19-53), and the mean body mass index was 42.6 ± 2.4 (40-49). Normal skin findings were present in 28.3% of the patients (17 patients). The most common finding was striae, and 60% (36 patients) had it. Then respectively, intertrigo was detected in 14 patients (23%), chronic recurrent folliculitis in 12 patients (20%), eczema in 5 patients (8.3%), and acanthosis nigricans in 2 patients (3.3%). Conclusion: The most common findings on the abdominal wall skin of obese individuals are striae and intertrigo, and similar findings have been found in many studies in the literature.

Background. Mutations in insulin receptor genes can cause severe insulin resistance syndrome. Compared with Rabson-Mendenhall Syndrome and Donohue’s Syndrome, type A insulin resistance syndrome is generally not serious. The main manifestations in woman with type A insulin resistance syndrome are hyperinsulinemia, insulin resistance, acanthosis nigricans, hyperandrogenism, and polycystic ovary. Case Presentation. A 13-year-old girl (Han nationality) visited the hospital due to hairiness and acanthosis nigricans. Further examination revealed severe hyperinsulinemia, insulin resistance, elevated blood glucose, hyperandrogenism, and polycystic ovary. Analysis of the insulin receptor gene by sequencing showed the presence of a nucleotide change in intron 7 (c. 1610+1G > A). The mutation was a splicing mutation, which can obviously affect the mRNA splicing of the insulin receptor and cause its function loss. The patient was finally diagnosed with type A insulin resistance syndrome. After 2 months of metformin treatment, the patient had spontaneous menstrual cramps and significantly improved acanthosis nigricans and sex hormones. Conclusion. We report for the first time a new splicing mutation on the insulin receptor gene at the 7th intron (c.1610+1G > A), which leads to type A insulin resistance syndrome. In clinically suspected patients with polycystic ovary syndrome, if there are extremely high blood levels of insulin in the blood, genetic testing should be performed to detect insulin receptor gene mutation of type A insulin resistance syndrome.

Nevoid acanthosis nigricans is a rare, benign form of acanthosis nigricans. Of the 24 cases documented in the literature, only two are exclusively localized to the umbilicus. We present four cases of nevoid acanthosis nigricans localized to the umbilicus; in patients less than 25 years of age, with no known co-morbidities, three of whom were females. Two of the cases received, with good response, treatment based on topical calcipotriol, a medication not previously reported to be used for this indication. Contrary to other types of acanthosis nigricans, the nevoid acanthosis nigricans is not associated with any syndrome, endocrinopathy, obesity, medication, or neoplasia and it can be confused with other pathologies such as epidermal nevus or dermatosis neglecta.

Acanthosis nigricans (AN) is a rare cutaneous condition that may be a manifestation of certain endocrinological or autoimmune diseases, as well as a potential marker for underlying undiagnosed cancer. AN is classified as either benign or malignant based on its clinical associations. Malignant acanthosis nigricans (MAN), which tends to be extensive and develops rapidly, is considered to be a paraneoplastic syndrome associated with advanced cancer, commonly accompanied by intra-abdominal malignancies. Bladder cancer with AN concomitant with tripe palms (TP) and/or mucosal involvement is relatively rare and, to our knowledge, only seven cases of AN with bladder cancer have been reported in the English literature. However, to date, there have been no reports of bladder cancer with AN concomitant with TP, skin and mucosal involvement. Here, we present a case of a 71-year-old male diagnosed with AN coexisting with recurrent bladder cancer and simultaneous TP and oral AN. In addition, we provide a brief review of the available literature on this topic. Early recognition of skin features associated with internal malignancies provides an opportunity for early diagnosis, treatment of the internal malignancy and monitoring of tumor recurrence.

Background: Acne vulgaris is a common dermatological disorder. Several hormones are suspected to play a role in its etiopathogenesis. Aims and Objectives: The aim of this study was to analyze the role of sex-hormones, metabolic status, and obesity in acne vulgaris and correlate with its severity and symptom load. Materials and Methods: This cross-sectional observational study included 89 female patients with acne vulgaris and certain phenotypic markers such as prepubertal onset, late-onset, persistent course, hirsutism, acanthosis nigricans, acrochordons, premenstrual flare, and diminished response to isotretinoin; suggestive of an underlying hormonal pathology. All patients were subjected to physical examination to rule out obesity and metabolic syndrome along with serum biochemistry to detect sex hormones (testosterone, progesterone, estrogen), serum insulin and insulin resistance (HOMA-IR) and lipid profile. Results: Among 89 patients (mean age 21.3 ± 5.3 years), 34.8% presented with late-onset/persistent/pre-pubertal acne, 33.7% presented with premenstrual flare and 28.2% presented with hirsutism. Hormonal analysis revealed elevated testosterone and progesterone with low estrogen across all categories of patients. Testosterone was significantly elevated even in mild acne. Serum lipid profile was altered significantly only in hirsute females. In total, 36% and 20.2% patients presented with metabolic syndrome and obesity, respectively; however, neither was associated with severity of acne. Conclusion: Sex-hormones, serum lipids, metabolic status, and body mass index are altered in acne vulgaris. All acne patients with endocrine markers should be evaluated for sex-hormones irrespective of severity and symptom load, whereas hirsutism may be regarded as clinical marker of lipid abnormalities. Metabolic syndrome and obesity do not seem to be directly correlated with acne severity. Thus, anti-androgens may be considered as adjuvant therapy in these patients, not responding to conventional therapy.

Background: Whether HAIR-AN syndrome and polycystic ovarian syndrome (PCOS) are distinct entities or represent a phenotypic spectrum of the same syndrome is still unclear. HAIR-AN syndrome is characterized by high insulin resistance, obesity, and hyperinsulinemia as compared to PCOS and could represent adipose tissue dysfunction as the primary pathophysiologic trigger. This study was undertaken to study the role of adipose tissue dysfunction in HAIR-AN syndrome and PCOS using adipocytokines as surrogate markers of “adiposopathy.” Materials and Methods: A cross-sectional observational study was conducted at a tertiary care hospital over a period of 1 year. Serum adiponectin, leptin, IL-6, and TNF-α levels were measured in 30 women with HAIR-AN syndrome and in 30 women with PCOS. Correlations between adipocytokines, inflammatory markers, serum testosterone, and serum insulin were determined. Data analysis was performed using the SPSS version 23.0 (IBM SPSS Statistics Inc., Chicago, IL, USA) software program. Results: Women with HAIR-AN syndrome had significantly higher hyperandrogenemia, hyperinsulinemia, and insulin resistance as compared to PCOS women. They also had high leptin levels and lower adiponectin levels (p < 0.001). However, the levels of inflammatory markers (TNF-α and IL-6) were similar in both the groups (p > 0.05). Serum adiponectin showed a negative correlation with HOMA-IR and testosterone levels, while leptin showed a positive correlation with both in HAIR-AN patients while no such correlation was found in the PCOS group. Conclusion: The significantly raised adipocytokines in HAIR-AN syndrome patients as compared to PCOS patients indicates the primary role of adipose tissue dysfunction (“adiposopathy”) in the pathogenesis of HAIR-AN syndrome while only a minor role, if any, in PCOS. Both these syndromes stand as distinct entities pathogenically with an overlapping phenotype.

Background: Obesity is a global epidemic. Obesity is associated with a number of dermatoses, including acanthosis nigricans, skin tag, keratosis pilaris, hyperandrogenism and hirsutism, striae distensae, and adiposis dolorosa. Objective: To elucidate the various skin changes in obesity and to determine if it is considered as an obesity marker. Methodology: 100 patients, aged 18 years or above satisfying the inclusion and exclusion criteria were drawn for a period of 18 months. Results: Out of 100 patients 54% were female, in their third and fourth decade. By occupation most of the females were housewives (40%) and the majority of males were farmers (14%). Type 2 diabetes mellitus was the most common systemic illness (24%). Pseudoacanthosis nigricans was the most prevalent skin change. 51% of patients had skin tags. 48% had striae distensae as a skin change. 10.86% male and 14.81% female patients had stasis dermatitis, 6% had leg venulectasias and 2% had leg ulcer. 26% had plantar hyperkeratosis. 41% of our patients had one or other types of fungal infections. Bacterial infections were detected in 15% cases, folliculitis being the commonest. Conclusion: Obesity is strongly related to several skin alterations that could be considered as markers of excessive weight. The dermatoses that showed a statistically significant relationship with obesity were Pseudo acanthosis nigricans, Skin tag, Striae, Plantar hyperkeratosis and Fungal infections. Prevention of obesity is important to prevent these dermatoses and dermatologists must work with primary care physicians and patients to reduce the harmful effects of obesity on the skin.

Acanthosis nigricans with tripe palms is one of the skin manifestations of systemic conditions, as well as internal malignancy. There have been reports of this paraneoplastic condition’s association with orocutaneous papillomatosis, but investigations into its relationship with diffuse esophageal papillomatosis are scarce. We report a case of acanthosis nigricans with tripe palms that was associated with diffuse esophageal squamous papillomatosis. A 40-year-old Thai woman with underlying systemic lupus erythematosus and secondary Sjögren’s syndrome, who was recently diagnosed with acanthosis nigricans and tripe palms was investigated for occult gastrointestinal malignancy. An upper GI endoscopy revealed diffuse squamous papilloma along the entire esophagus and lower GI endoscopy revealed one pedunculated hyperplastic polyp 1 cm in size at the sigmoid colon. Long-term follow-up is needed to reassure these coexisting conditions belonging to benign systemic diseases without hidden malignancy.

Introduction: Metabolic syndrome is a cluster of metabolic risk factors which includes central obesity, glucose intolerance, hyperinsulinemia, low HDL cholesterol, high triglycerides and hypertension. Acanthosis nigricans, the principal abnormality in metabolic syndrome (MetS), is an easily identifiable asymptomatic non-specific reaction pattern of skin characterized by thickened, hyperpigmented plaques associated with hyperinsulinemia. Aims and Objectives: To determine the prevalence of metabolic syndrome and AN in adolescent and adults and the association between benign acquired AN and metabolic syndrome. Materials and Methods: A sample of 40 patients selected from Dermatology outpatient department who satisfied the selection criteria to evaluate the prevalence of AN and its association with insulin resistance and the clustering of the MetS components. Epidemiological, clinical and anthropometric characteristics (height, weight, waist circumference) were measured and BMI was calculated. We used the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria for the diagnosis of metabolic syndrome. Results: The average age of the study population was 26.8 years, with male to female ratio of 1:1. The prevalence of acanthosis nigricans among females is greater than males, which also showed a positive correlation with increase in the age. BMI was higher in patients with metabolic syndrome than the patients without metabolic syndrome.There was a statistically significant correlation of increasing incidence of AN with each component of metabolic syndrome. Conclusion: There is an increased prevalence of MetS in the individuals with AN which was statistically highly significant. Hence, early screening of a simple clinical marker like AN is helpful in identification of MetS components.

Background Hirsutism is common across ethnicities and a significant cause of negative self-esteem from presumptive loss of femininity. It remains understudied in Indian patients. Objective We studied the clinical and investigative attributes of patients with hirsutism. Methods The medical records of 233 patients with hirsutism diagnosed between 2014 and 2019 were analyzed retrospectively. Results The complete records of 122 patients age 14 to 45 years were available. Approximately 32% were adolescents, and 50% patients were age 21 to 30 years. The mean ± standard deviation modified Ferriman-Gallway (mF-G) score was 17.95 ± 10.58, and hirsutism was graded zero/mild in 57.4% patients. Polycystic ovaries were present in 29.5% of patients. Serum-free testosterone levels were elevated in 16.4% of patients. Associated signs of clinical hyperandrogenism, such as acne, obesity, acanthosis nigricans, and menstrual irregularities, were present in 12 patients (9.8%). Familial hirsutism occurred in 13% of patients and was idiopathic in 10.7% of patients. Significantly more patients (47.7% vs. 27.9%) with severe hirsutism did not complete investigations compared with those with mild hirsutism (45.9% vs. 21.6%), which may be due to the high cost of investigative work-up (as often stated by many patients) compared with periodic depilation. Limitations The mF-G score is a visual and subjective scale, and its validity remains limited by interobserver variations. The score's cut-off values may vary among races/ethnicities. A small number of patients and the retrospective study design are other limitations. Conclusion Hirsutism of polycystic ovary syndrome or idiopathic origin is not uncommon in Indian women. Hirsutism of adrenal or thyroid origin remains uncommon. Self-referral and high cosmetic concerns for facial hair were common in adolescents and young unmarried patients, and the majority had an mF-G score of

Insulin-derived amyloidosis (AIns) is a rare iatrogenic subtype of cutaneous amyloidosis occurring at frequent insulin injection sites. Here, we describe 2 cases of AIns accompanied by acanthosis nigricans (AN)-like changes, a rare finding which has been reported fewer than 5 times in the literature. We also report the first case of an AIns nodule being misdiagnosed as a keloid. Both of our patients presented with asymptomatic, hyperkeratotic, pigmented plaques at frequent insulin injection sites, and histopathologic examination showed (1) nodular aggregates of amyloid demonstrating apple-green birefringence with Congo red staining and (2) AN-like features, such as epidermal papillomatosis, hyperkeratosis, and hyperpigmentation. Accurate diagnosis of AIns is crucial, because repeated insulin injection into a nodule can impair glycemic control. However, misdiagnosis is common, as observed with our second patient, whose AIns nodule was misdiagnosed by an outside provider as a keloid, perhaps because of the presence of AN-like features. Our case report adds to the limited but growing body of literature on AIns and significantly increases the number of reported cases of AIns with AN-like features, an even rarer phenomenon.

Confluent and reticulated papillomatosis (CARP) is a dermatosis that often presents during adolescence. Prior studies have linked CARP to metabolic syndrome and comorbidities associated with insulin resistance, such as acanthosis nigricans and type 2 diabetes. Despite this, few studies have evaluated the clinical relationship between glucose dysmetabolism and CARP. In this report, we describe the characteristics of a large cohort of pediatric patients with CARP to further evaluate the potential relationship between CARP and metabolic syndrome in children.

Tripe palm is a rare cutaneous paraneoplastic syndrome that can be overlooked and frequently appears with acanthosis nigricans. If tripe palm and acanthosis nigricans occur in a patient together, gastric cancer should come to mind. A 50-year-old female patient had signs of abdominal pain and velvety thickening in the palms and soles. Tripe palm and acanthosis nigricans were considered as paraneoplastic syndrome after other benign causes were excluded. It was determined that the underlying malignancy was gastric cancer. After neoadjuvant FLOT chemotherapy regimen, gastrectomy was performed, and the patient received adjuvant chemotherapy. With the recognition of tripe palm, a rare cutaneous paraneoplastic syndrome, patients can be diagnosed and treated early.