Acanthosis nigricans--decreased extracellular matrix viscosity: cancer, obesity, diabetes, corticosteroids, somatotrophin

Diet and Acanthosis Nigricans over a Two-Year Period in Children of the Pacific Region

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.

Acanthosis nigricans in middle-age adults: A highly prevalent and specific clinical sign of insulin resistance

BACKGROUND

Insulin resistance (IR) precedes the diagnosis of many metabolic and non-metabolic illnesses, including type 2 diabetes mellitus (T2DM). Acanthosis nigricans (AN) is a clinical sign associated with IR. However, AN prevalence and diagnostic accuracy in middle-age adults before or at the time of prediabetes/diabetes diagnosis remain uncertain.

METHODS

With the aim to define AN prevalence and diagnostic accuracy, adults between 40 and 60 years of age were consecutively invited to participate in the study. Participants were categorised into one of two main groups: individuals with normoglycaemia (group 1) and hyperglycaemia (group 2 [ie, prediabetes/diabetes]). Demographic, clinical, anthropometric characteristics, homeostasis model assessment of IR, homeostatic model assessment of β-cell function, as well as the presence of AN on the neck, axillae, elbows and knuckles were assessed.

RESULTS

A total of 320 consecutive participants with a mean age of 49.3 years (59.4% women) were included. Overall, AN prevalence was 46.3%, while AN in group 1 and group 2 was 36.3% and 49.6%, respectively (P = .04). The most common affected sites in group 1 (n = 80) were the knuckles (21.2%) and the neck (17.5%), while in group 2 (n = 240), the neck (29.6%) followed by the knuckles (26.7%). The specificity and positive predictive value of AN for IR were 0.85 and 0.86 in group 1 and 0.90 and 0.96 in group 2, respectively.

CONCLUSIONS

In middle-age adults, within the entire spectrum of carbohydrate tolerance, AN is highly prevalent and specific. This finding supports its assessment as a reliable and convenient clinical sign of IR. The understanding of AN behaviour through different carbohydrate tolerance strata, and its different locations, could lead to early detection of individuals at high metabolic risk or help direct a more pathophysiological treatment approach in patients with T2DM.

Frequency of various types of neoplasia in a group of acromegalic patients

OBJECTIVE

To determine the frequency of colon cancer, primary hyperparathyroidism, thyroid tumor, and skin cancer in all acromegalic patients in follow-up at the Clinics Hospital - Botucatu Medical School, from 2005 to 2011.

SUBJECTS AND METHODS

These patients were evaluated retrospectively for colon cancer, primary hyperparathyroidism, dermatological, and thyroid tumors.

RESULTS

Of 29 patients included at the beginning of the study, two were excluded. Among 19 patients submitted to colonoscopy, one presented colon adenocarcinoma (5%). Thyroid nodules were present in 63% of patients, and papilliferous carcinoma was confirmed in two patients (7,7%). Four patients were confirmed as having primary hyperparathyroidism (15%). The most common dermatologic lesions were thickened skin (100%), acrochordons (64%), epidermal cysts (50%), and pseudo-acanthosis nigricans (50%). Only one patient presented basal cell carcinoma.

CONCLUSION

Although a small number of acromegalic patients was studied, our findings confirm the high frequency of thyroid neoplasias and primary hyperparathyroidism in this group of patients.

Skin manifestations in acromegaly

Cutaneous changes in acromegaly result from excess GH and IGF-1 action on skin cells and adnexae. Skin puffiness due to dermal glycosaminoglycan accumulation and edema are most prominent in the face, hands and feet. Oily skin with large pores, hypertrichosis, and excessive sweating are common features. Pigmented skin tags, acanthosis nigricans, and psoriasis are also encountered. Alteration in skin capillaries produce increased vasoconstriction. Discerning these changes contributes to early diagnosis and treatment of this high-morbidity disorder. Controlling GH and IGF-1 over-secretion alleviates most cutaneous manifestations of acromegaly; however, regression may be incomplete.

Prevalence of Acanthosis Nigricans in Newly-Diagnosed Type 2 Diabetes

OBJECTIVE

To determine the prevalence of acanthosis nigricans in a population of patients with newly-diagnosed type 2 diabetes mellitus.

METHODS

Chart review of men and women treated for newly diagnosed type 2 diabetes at the University Diabetes Treatment Center at Parkland Health and Hospital System in Dallas, Texas between January 1998 and December 1999. The presence of acanthosis nigricans was evaluated on the posterior neck of each individual.

RESULTS

Of 216 patients identified with newly diagnosed type 2 diabetes, 78 individuals (36.1%) presented with acanthosis nigricans involving the back of the neck. Most subjects were obese, with the mean BMI of the subject population at 32.7 +/- 5.8 kg/m2 (mean +/- SD). Prevalence of acanthosis nigricans increased with degree of obesity, with fully 54.1% of the population with a BMI of > or = 30 kg/m2 manifesting the skin lesion. The prevalence of acanthosis nigricans differed notably among ethnic groups, as the lesion occurred in 50 (52.6%) of 95 African-American subjects and 28 (35.9%) of 78 Latin-American subjects. Patients with acanthosis nigricans required markedly higher insulin doses (82.3 +/- 7.2 units/day) to achieve euglycemia compared to those without the disorder (50.2 +/- 5.7 units/day).

CONCLUSION

These results suggest that acanthosis nigricans is a readily visible marker of hyperinsulinemia and is frequently encountered in patients with type 2 diabetes. Prevalence of acanthosis nigricans is influenced by ethnicity and BMI in this patient population.

Malignant acanthosis nigricans and endometrioid adenocarcinoma of the parametrium: the search for malignancy

Malignant acanthosis nigricans is recognized as a cutaneous sign of internal malignancy, usually an adenocarcinoma. Although cases of malignant acanthosis nigricans have been associated with cervical, ovarian, and endometrial neoplasms, we describe a case with a rarely if ever reported association, endometrioid adenocarcinoma of the parametrium.

Malignant acanthosis nigricans and tripe palms in a patient with endometrial adenocarcinoma--a case report and review of literature

BACKGROUND

In the world literature, uterine carcinoma associated with paraneoplastic malignant acanthosis nigricans and tripe palms has been mentioned in two review articles. Endometrial adenocarcinoma associated with malignant acanthosis nigricans without tripe palms has been cited in three case reports, and endometrial adenocarcinoma associated with tripe palms without malignant acanthosis nigricans has been cited in one case report. We present the case of a patient with endometrial adenocarcinoma associated with acanthosis nigricans and tripe palms which we have been following for the past 7 years.

METHODS

Our 54-year-old patient had been operated for moderately differentiated endometrial adenocarcinoma. She had also received postoperative radiotherapy.

RESULTS

Three years after surgery, tripe palms and acanthosis nigricans with generalized pruritus occurred. After treatment with etretinate, the skin symptoms were somewhat mitigated while the pruritus persisted. Six years after gynecologic treatment, a solitary inguinal metastatic lymph node of endometrial carcinoma was detected. Following lymphadenectomy there was additional but not complete mitigation of skin symptoms including pruritus.

CONCLUSIONS

In clinical practice the association of malignant acanthosis nigricans and tripe palms with endometrial adenocarcinoma is found extremely rarely. Although the survival time of adenocarcinoma patients with malignant acanthosis nigricans is short, our patient has been treated and followed for more than 7 years.

Acanthosis nigricans

Acanthosis nigricans is a mucocutaneous eruption that occurs in a strikingly exuberant form as a marker for a highly malignant and rapidly fatal internal cancer. Recently, it has been recognized that acanthosis nigricans may also be a relatively common marker for increased long-term risk of the less dramatic but potentially serious systemic disorders associated with insulin resistance and compensatory increased insulin secretion.

Dermatomyositis/polymyositis associated with internal malignancy: a consequence of how neoplasms alter generalized extracellular matrix in the host

The mechanism of dermatomyositis/polymyositis (DM/PM) is unknown. There are multiple probable trigger mechanisms. Internal malignancy is a specific trigger for some cases of DM/PM. It is known that there are marked changes in the extracellular matrix around tumors and that various fractions of depolymerized glycosaminoglycans enter the circulation. Circulating ECM fractions are known to incorporate in the extracellular matrix (ECM). Skin changes in DM include mucin formation, edema, and atrophy. These are not post inflammatory changes. These changes could be a consequence of the tumor's effect in the generalized ECM. Many factors influence ECM. Infections are another probable trigger for DM/PM. Infections induce extracellular matrix changes. It is likely that a role for infectious agents in DM/PM will eventually be defined. The drug D-penicillamine is also a trigger for DM/PM. Understanding the mechanism of any one trigger might aid in helping define other triggers. Four other cutaneous signs of internal malignancy can be explained by the mechanism used to explain DM/PM.