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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.

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.

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.

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.

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.

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.

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

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.

Background Acanthosis nigricans (AN), Leser-Trelat sign, and tripe palm are all skin diseases. To date, reports of these appearing as a paraneoplastic syndrome in a gastric cancer patient are quite rare. Case summary We report the case of a 61-year-old man with darkened skin color in the face and torso with no obvious inducement after 1 year of treatment for Riehl's melanosis. He had 40 brown maculopapular eruptions on his face and the top of his head with obvious itching. Papillary wart-like hyperkeratosis with dark brown pigmentation was also observed on both sides of the areola. He had papilloma-like lesions on the face, around the orbit, and on the neck. His bilateral palms had small, smooth, papillary projections with millet-like appearance. Histopathological examination of the skin showed that the patient was suffering from AN, tripe palms, and Leser-Trelat sign. Gastroscopy showed the patient's cardia was affected, and pathological biopsy revealed that he had moderate-to-poorly differentiated adenocarcinoma. Computed tomography test results showed that his cardia wall had thickened. Based on these histological and skin characteristics, the patient was diagnosed with gastric cancer with AN, tripe palms, and Leser-Trelat sign. Conclusion Researchers should follow up on patients with malignant AN, Leser-Trelat sign, and tripe palms.

Background. Polycystic ovary syndrome (PCOS) is a common endocrine disorder with heterogeneous etiology. Typical features consist of oligo/anovulation, polycystic ovaries, and features of hyperandrogenism. Pathogenesis is multifactorial, and positive family history may have a predisposition for disease development. The syndrome is associated with multiple metabolic and nonmetabolic entities. As the disease is involved with multiple adverse outcomes, the successful treatment is pivotal. Among the more advanced options, the unilateral oophorectomy is considered as a last resort to alleviate the symptoms. Case Presentation. A 29-year-old female presented to us with oligomenorrhea, severe hirsutism, androgenic pattern hair loss, acne, increased skin pigmentation, and secondary subfertility. On examination, she was obese with a body mass index (BMI) of 29.6 kg/m2. She had evidence of acanthosis nigricans, androgenic pattern balding, acne, dorsal, supraclavicular fat deposition, and moderate-severe hirsutism. Investigations confirmed excess right ovarian testosterone secretion which led to the ultimate management with right oophorectomy with successful alleviation of clinical features. Conclusions. The multifaceted medical treatment comprises the first-line therapy in PCOS. Surgery is considered as a second-line option in resistant PCOS following failure of initial therapeutic options. We report a case of resistant polycystic ovary syndrome with secondary subfertility and moderate-to-severe hirsutism who was successfully treated with unilateral oophorectomy with favorable results.

Objectives Acanthosis nigricans is a skin symptom in obesity that helps to identify patients at high risk for dyslipidemia, hypertension, insulin resistance, and diabetes. It is the most important complication of obesity in metabolic syndrome. Studies investigating the relationship between acanthosis nigricans and metabolic syndrome in obese children are insufficient. In our study, the relationship of acanthosis nigricans and metabolic syndrome was evaluated in children. Methods Obese children aged between 6 and 18 years old, who were examined in the pediatric endocrinology outpatient clinic, were included. The patients’ anthropometric measurements and laboratory results were recorded. Modified IDF (International Diabetes Federation) criteria for children were used in metabolic syndrome classification. Results A hundred and forty-eight obese children were evaluated. The mean age of the cases was 11.91 ± 2.94 years old. Of the cases, 56.1% were female (n=83) 43.9% (n=65) were male. In 39.9% (n=59) of cases, acanthosis nigricans was determined. Acanthosis nigricans was mostly located in the axillary area (27.1%) and the neck (16.9%). In 55.9% of the cases, it was located in more than one area. The relation of regionally detected acanthosis nigricans and metabolic syndrome was not significant (p=0.291). Metabolic syndrome was detected in 14% of 136 patients according to IDF criteria. Acanthosis nigricans and metabolic syndrome combination was present in 27.7%; however, 6.7% of the metabolic syndrome patients did not have acanthosis nigricans. There was a strong relation between metabolic syndrome and the presence of acanthosis nigricans (p=0.003). Conclusions In our study, a correlation between acanthosis nigricans and metabolic syndrome was detected. Acanthosis nigricans is a skin sign that can be easily detected by clinician. It is an important and easy-to-detect dermatosis that helps determine patients at risk of metabolic syndrome in obese children.

Objective 3-M syndrome is characterized by severe short stature, syndromic features, and characteristic radiographic findings. Growth hormone (GH) has been used with variable success. Recombinant human insulin like growth factor-1 (rhIGF-1) has never been utilized. Case presentation We describe a child with severe growth retardation, macrocephaly, and skeletal abnormalities with evidence of GH insensitivity subsequently treated with rhIGF-1. He developed morbid obesity and comorbidities including voracious appetite, acanthosis nigricans, tonsillar hypertrophy, and severe obstructive sleep apnea with minimal height improvement. Genetic testing done at 11.5 years revealed a compound heterozygous mutation (c.2112G>A(p.W704X) and c.2559delC) in the CUL7 gene consistent with 3-M syndrome-1. rhIGF-1 therapy was discontinued. Conclusions This case highlights the novel use of rhIGF-1 therapy on a child with 3-M syndrome-1 with minimal height benefit but accelerated weight gain and serves as a reminder of the importance of re-evaluating therapy efficacy and side effect profile.

BACKGROUND Type A insulin resistance syndrome is a rare disorder caused by mutations in the gene encoding the insulin receptor. Its coexistence with ovarian serous papillary cystadenofibroma is even rarer. CASE SUMMARY A 14-year-old girl developed type A insulin resistance syndrome and showed high fasting insulin, glucose, and hemoglobin A1c (HbA1c) levels. The girl suffered from ovarian serous papillary cystadenofibroma. The laboratory results were as follows: fasting insulin was 2624.90 pmol/L and HbA1c was 8.5%. A heterozygous missense mutation on exon 20 of the insulin receptor gene (c.3601C>T, Arg1201Trp) was observed. The histopathological diagnosis was a cystic lesion that extended to the upper right uterus, indicating a right ovarian serous papillary cystadefibroma accompanied by focal interstitial hyperplasia. The patient was treated with metformin for over 6 mo. Additionally, laparoscopic resection (bilateral) of the ovarian lesion and laparoscopic intestinal adhesiolysis were performed under general anesthesia. Diet therapy combined with exercise was then initiated. The patient had an uneventful recovery. The patient also showed improved blood glucose control, with reduced levels of fasting insulin (857.84 pmol/L) and HbA1c (7.0%). CONCLUSION Insulin resistance may play a significant role in the induction of tumors. It is important to investigate further the association between insulin resistance and tumors and the underlying mechanism.

Background Patients with hirsutism have an increased number of psychological diseases including depression, anxiety, and social isolation with decreased quality of life. Aims We aimed to investigate changes in the quality of life of patients with hirsutism among Turkish women. Methods A total of 57 patients diagnosed with hirsutism were included in this study. The patients were investigated in terms of Dermatological Life Quality Index (DLQI) score, concomitant clinical findings, and polycystic ovary syndrome. Modified Ferriman-Gallwey (mFG) was used for the diagnosis of hirsutism. Results The mean DLQI score of the patients was 9.80 ± 6.50, while the median value of the mFG score was 25 (minimum 8, maximum 34). The mean DLQI score of patients who had an mFG score of four only in one region of the face was statistically higher than women with an mFG score less than four (P = .033). No statistically significant correlation was found between DLQI and mFG scores (P = .254). There was no statistically significant difference in terms of DLQI between women with acne, seborrhea, androgenetic alopecia, menstrual irregularity, or acanthosis nigricans versus those without them (P >.05). The mean DLQI score was statistically significantly higher for patients with PCOS than for those without PCOS (P = .004). Conclusion As shown by mFG score, quality of life is affected in certain areas for women with hirsutism. The mFG score is not correlated with the quality of life score. Certain areas of excessive hair that lead to stigma may be more important in quality of life for these women. The quality of life seems to be significantly more affected in hirsutism patients with PCOS than those without PCOS. Finally, clinical symptoms and signs appear to have no important role in the quality of life of patients with hirsutism.

Introduction:Metformin is an antihyperglycemic medication most commonly used to treat Type II Diabetes Mellitus with promising off-label application for the treatment of hidradenitis suppurativa, psoriasis, acne, acanthosis nigricans, and hirsutism. Objective: To comprehensively assess evidence regarding the use of metformin for treating primary cutaneous disorders. Materials and Methods: A systematic literature search was conducted through PubMed, Cochrane, Web of Science, and CINAHL to identify the role of metformin in primary skin disease. Results: Sixty-four studies met inclusion criteria. Metformin demonstrates promising clinical response and favorable safety profile for treatment of HS, with most patients experiencing a decrease in frequency or severity of HS flares, and some experiencing full resolution of HS lesions. Patients with psoriasis treated with metformin experienced quantifiable clinical responses. Application of metformin on polycystic ovarian disease (PCOS) related acne, acanthosis nigricans, and hirsutism yielded mixed clinical results. No serious adverse effects were reported. Conclusion: Metformin is safe and efficacious and may be considered as an adjunctive therapy for the treatment of psoriasis and hidradenitis suppurativa in addition to first line therapies as well as PCOS related acne, acanthosis nigricans, and hirsutism. J Drugs Dermatol. 2020;19(8): doi:10.36849/JDD.2020.4874.

Background: Diabetes mellitus (DM) is the most common endocrine disorder1.At least 30% of diabetics have some cutaneous involvement during the course of their disease 1. Type II patients do develop more frequent cutaneous infections, whereas type I patients develop more autoimmune- type cutaneous lesions 2,3. Objective: To evaluate the prevalence and pattern of skin manifestations among diabetic patients. Methods: 100 patients of diabetes mellitus with skin manifestations who consecutively attended DVL outpatient department and willing to participate in the study were enrolled in this study. Skin examination was done and findings entered to computer database for analysis. Results: Among 100 patients, there were 56 males and 44 females the youngest patient being 19 years old and eldest was 77 years old. Cutaneous infections were the most commonly observed dermatoses (51%), followed by dermatoses more commonly associated with diabetes mellitus (36%), non specific dermatoses (23%), neuropathic and ischemic diabetic skin disease (5%), due to microangiopathy (4%), metabolic disorders (3%) and cutaneous reactions to therapy (3%).Among cutaneous infections, fungal infections (38%) are the most common dermatoses followed by bacterial infections (11%) and viral infections (2%). Tinea corporis was the most common fungal infection and furunculosis (3%) was most common bacterial infection. Among the common dermatoses associated with diabetes mellitus (36%) majority presented with pruritus secondary to xerosis (12 patients, 12%) followed by 11 cases (11%) of psoriasis, 4 cases of vitiligo, 2 patients each (2%) of acrochordons, lichen planus and macular amyloidosis, 1 patient each (1%) of acanthosis nigricans, alopecia universalis and kyrles disease. Among patients with non specific dermatoses, eczema was most common followed by pemphigus, acne vulgaris and hidradenitis suppurativa. Conclusion: Infections were the most common cutaneous manifestations in diabetes, followed by dermatoses most commonly associated with diabetes. Cutaneous manifestations are more common in patients who have overall poor glycemic control. Cutaneous manifestations can heighten the suspicion of a physician regarding the diagnosis of diabetes and help to prevent systemic derangements by early institution of appropriate treatment.

Dermal paraneoplastic syndromes are non-malignant disorders, caused indirectly by the increase in growth factors or as immunological reactions, which lead to a variety of inflammatory, hyperkeratotic or proliferative skin reactions. They can occur as facultative or obligate paraneoplastic dermatoses, which are associated with oncological processes (solid tumours or hematologic diseases). The recognition of paraneoplastic skin disorders can accelerate proper diagnosis and determine better prognosis for the patient and is also important to clinicians because it is often the first symptom of life-threatening malignancies. Many of them may also cause ocular changes that can lead to serious complications including perforation of the eye bulb, vascular changes in the retina resulting in vision loss and demand multidisciplinary co-operation with an ophthalmologist. This manuscript is a review of the literature about eye disorders in association with dermal paraneoplastic syndromes.

El objetivo del estudio fue determinar las alteraciones metabólicas presentes en los escolares con obesidad que asisten a la consulta de Endocrinología Pediátrica de la Clínica Doctor Virgilio Cedano, desde enero hasta junio 2019, en el municipio de Higüey, provincia La Altagracia. Se realizó un estudio descriptivo, observacional, de corte transversal con colección retrospectiva de datos, donde fueron evaluados 68 expedientes clínicos durante el período enero-julio 2019. Al finalizar la investigación, se concluye que las principales alteraciones metabólicas encontradas en los escolares con obesidad fueron la acantosis nigricans, la deficiencia de vitamina D y las dislipidemias. El sexo femenino fue el más frecuente. El 38 % de los pacientes obesos tuvieron antecedentes familiares patológicos de Diabetes Mellitus tipo 2. El 49 % de la población estudiada tiene Insulinorresistencia. La mayoría de los escolares obesos tienen obesidad central. El 48 % de los pacientes con obesidad central tiene insulinorresistencia. La resistencia a la insulina está presente en la mayoría de los pacientes con alteraciones metabólicas.

Summary HAIR-AN syndrome, the coexistence of Hirsutism, Insulin Resistance (IR) and Acanthosis Nigricans, constitutes a rare nosologic entity. It is characterized from clinical and biochemical hyperandrogenism accompanied with severe insulin resistance, chronic anovulation and metabolic abnormalities. Literally, HAIR-AN represents an extreme case of polycystic ovary syndrome (PCOS). In everyday practice, the management of HAIR-AN constitutes a therapeutic challenge with the available pharmaceutical agents. Specifically, the degree of IR cannot be significantly ameliorated with metformin administration, whereas oral contraceptives chronic administration is associated with worsening of metabolic profile. Liraglutide and exenatide, in combination with metformin, have been introduced in the management of significantly obese women with PCOS with satisfactory results. Based on this notion, we prescribed liraglutide in five women with HAIR-AN. In all participants a significant improvement regarding the degree of IR, fat depositions, androgen levels and the pattern of menstrual cycle was observed, with minimal weight loss. Furthermore, one woman became pregnant during liraglutide treatment giving birth to a healthy child. Accordingly, we conclude that liraglutide constitutes an effective alternative in the management of women with HAIR-AN. Learning points: HAIR-AN management is challenging and classic therapeutic regimens are ineffective. Literally HAIR-AN syndrome, the coexistence of Hirsutism, Insulin Resistance and Acanthosis Nigricans, represents an extreme case of polycystic ovary syndrome. In cases of HAIR-AN, liraglutide constitutes an effective and safe choice.

Background: Polycystic ovarian disease (PCOD) is characterized by oligo/anovulation, ultrasonographic evidence of polycystic ovaries and cutaneous features such as hirsutism, acne, acanthosis nigricans, androgentic alopecia, and signs of virilization. Aim: Correlation of dermatological manifestations with body mass index (BMI), blood glucose, and levels of free testosterone, dehydroepiandrosterone sulfate (DHEAS), follicle stimulating hormone (FSH), and luteinizing hormone (LH) in patients of PCOD hailing from Pimpri, Pune. Subjects and Methods: This observational study was carried out from November 2015–April 2017 on 102 patients (aged 12–45 years, non-pregnant) of PCOD, attending dermatology/gynecology outpatient departments. After recording socio-demographic/menstrual and medical history, BMI was calculated and examination of cutaneous manifestations were done. Participants were then subjected to pelvic ultrasonography and blood sugar/hormonal estimation. Statistical Analysis: By using statistical package for the Social Sciences 17.0 software, Chi-square test, and Fisher's exact test. Results: Age: 59.80% belonged to the third decade (range,12–40; mean, 26.27 ± 5.05 years); ultrasonography revealed polycystic ovaries in 79.41%. Cutaneous manifestations recorded were – acne (74.50%); acanthosis nigricans (50%); striae (49.02%); hirsutism (40.19%); acrochordons (36.27%); seborrheic dermatitis (32.35%), and androgenetic alopecia (30.39%). Free testosterone (35;34.31%), DHEAS (9;8.82%), LH and FSH (2;1.96% each), and LH: FSH ratio (51;50%) were raised. Statistical association of acanthosis nigricans emerged with free testosterone (P = 0.034), DHEAS (P = 0.016), fasting blood sugar (P = 0.01), and raised BMI (P = 0.002) and of hirsutism with raised DHEAS (P = 0.016), free testosterone (P = 0.012), and BMI (P = 0.022). Conclusion: Significant correlations demonstrated were acanthosis nigricans with free testosterone, DHEAS, FBS, and BMI and hirsutism with DHEAS, free testosterone, and BMI.

Background To date, very little information is available concerning the relationship between acanthosis nigricans (AN) and infection with human immunodeficiency virus type 1 (HIV-1). Case presentation Herein, we report the case of a middle-aged man admitted for fever and progressively worsening dyspnea in the context of an opportunistic pneumonia and firstly diagnosed with acquired immunodeficiency syndrome (AIDS). At the time of diagnosis, physical examination revealed the presence of a palpable, hyperpigmented skin lesion on the left areola with surface desquamation and velvety texture consistent with AN. Of note, the most common primary etiologies related to AN were excluded and the complete regression of the skin lesion was observed once antiretroviral therapy was started. Conclusion This is the second report of AN found in patients with AIDS and apparently responsive to prolonged antiretroviral treatment. Possible explanations of this association are still not completely understood, probably related to virus-induced changes in lipid metabolism. Our experience suggests that HIV testing should always be considered in the setting of apparently idiopathic AN.