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Triwatcharikorn J, Itthipanichpong Y, Washrawirul C, Chuenboonngarm N, Chongpison Y, Udomsawaengsup S, Boonchaya-Anant P, Rerknimitr P. Skin manifestations and biophysical changes following weight reduction induced by bariatric surgery: A 2-year prospective study. J Dermatol 2023; 50:1635-1639. [PMID: 37665164 DOI: 10.1111/1346-8138.16951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/27/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
Skin manifestations and biophysical changes are observed in patients with morbid obesity. However, reports of changes after significant weight loss, particularly through post-bariatric surgery (BaS), are limited. The aim of this 2-year prospective study was to evaluate the prevalence of skin signs and their changes in patients with morbid obesity who underwent BaS. Thirty-one patients were recruited for the study, with a mean age of 38.35 (SD 10.61) years and a male preponderance (male = 19 [61.29%], female = 12 [38.71%]). Patients were scheduled for multiple visits at months 0, 3, 6, 12, 18, and 24 post-BaS. Each subject had a thorough skin examination, biophysical measurements, and laboratory tests at each visit. Striae, acanthosis nigricans (AN), and plantar hyperkeratosis were the most common skin findings (n = 30 [96.77%], 29 [93.55%], 29 [93.55%], respectively). BaS provided improvements in many skin manifestations, namely striae, AN, acrochordons, plantar hyperkeratosis, hirsutism, lymphedema, pruritus, acne, finger pebbles, and chronic venous insufficiency with varied cumulative rates of improvements. However, acute telogen effluvium was observed in 17 (54.84%) patients. Regarding skin biophysical properties, transepidermal water loss, skin hydration, and pH did not change, while sebum production on the face significantly decreased at months 3 and 6, and elasticity decreased at months 6 and 24. In conclusion, weight reduction by BaS provided improvements in various skin signs, although telogen effluvium was a common sequelae.
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Affiliation(s)
- Jidapa Triwatcharikorn
- Division of Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Yada Itthipanichpong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Chanudda Washrawirul
- Division of Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Nunthanach Chuenboonngarm
- Division of Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Yuda Chongpison
- Center for Excellence in Biostatistics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suthep Udomsawaengsup
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Treatment of Obesity and Metabolic Disease Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Patchaya Boonchaya-Anant
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pawinee Rerknimitr
- Division of Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
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Yusuf ANM, Amri MF, Ugusman A, Hamid AA, Wahab NA, Mokhtar MH. Hyperandrogenism and Its Possible Effects on Endometrial Receptivity: A Review. Int J Mol Sci 2023; 24:12026. [PMID: 37569402 PMCID: PMC10419014 DOI: 10.3390/ijms241512026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Endometrial receptivity is a state of the endometrium defined by its readiness for embryo implantation. When the receptivity of the endometrium is impaired due to hyperandrogenism or androgen excess, this condition can lead to pregnancy loss or infertility. Hyperandrogenism encompasses a wide range of clinical manifestations, including polycystic ovary syndrome (PCOS), idiopathic hirsutism, hirsutism and hyperandrogaenemia, non-classical congenital adrenal hyperplasia, hyperandrogenism, insulin resistance, acanthosis nigricans (HAIR-AN), ovarian or adrenal androgen-secreting neoplasms, Cushing's syndrome, and hyperprolactinaemia. Recurrent miscarriages have been shown to be closely related to elevated testosterone levels, which alter the endometrial milieu so that it is less favourable for embryo implantation. There are mechanisms for endometrial receptivity that are affected by excess androgen. The HOXA gene, aVβ3 integrin, CDK signalling pathway, MECA-79, and MAGEA-11 were the genes and proteins affect endometrial receptivity in the presence of a hyperandrogenic state. In this review, we would like to explore the other manifestations of androgen excess focusing on causes other than PCOS and learn possible mechanisms of endometrial receptivity behind androgen excess leading to pregnancy loss or infertility.
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Affiliation(s)
- Allia Najmie Muhammad Yusuf
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Mohd Fariz Amri
- Department of Pathology, Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Azizah Ugusman
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Adila A. Hamid
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Norhazlina Abdul Wahab
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mohd Helmy Mokhtar
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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O'Brien B, Dahiya R, Kimble R. Hyperandrogenism, insulin resistance and acanthosis nigricans (HAIR-AN syndrome): an extreme subphenotype of polycystic ovary syndrome. BMJ Case Rep 2020; 13:e231749. [PMID: 32276996 PMCID: PMC7167451 DOI: 10.1136/bcr-2019-231749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
HAIR-AN-a syndrome of hyperandrogenism (HA), insulin resistance (IR) and acanthosis nigricans (AN)-is a specific subphenotype of polycystic ovary syndrome (PCOS), and it is seen in almost 5% of all women with hyperandrogenism. An adolescent girl aged 11 years old was referred with adrenarche, hyperandrogenism and obesity commencing at age 8. Clinical and biochemical investigations confirmed significant hyperandrogenism and insulin resistance, and a diagnosis of HAIR-AN syndrome was made after exclusion of other differential diagnoses. HAIR-AN syndrome is an important diagnosis for the adolescent gynaecologist to be aware of, and it requires a multidisciplinary approach, including endocrinology input, for optimal management. Weight loss, lifestyle modification and combined hormonal pill and metformin are considered first-line treatment.
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Affiliation(s)
- Brooke O'Brien
- Paediatric and Adolescent Gynaecology, Department of Paediatric Surgery, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Rachana Dahiya
- School of Medicine, The University of Queensland, St Lucia, Queensland, Australia
- Department of Endocrinology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Rebecca Kimble
- Paediatric and Adolescent Gynaecology, Department of Paediatric Surgery, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Women's and Newborn Services, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
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Abstract
PURPOSE OF REVIEW Acne vulgaris is a global disease with increasing prevalence in adolescents. It has a profound impact on their quality of life, especially when endocrine disorders are also involved. Recent concerns regarding antibiotic stewardship, failures with antibiotic usage, and the development of antibiotic-resistant Propionibacterium acnes have led clinicians to consider other therapeutic options for acne treatment. The present review explores hormonal therapies for the treatment of acne vulgaris. RECENT FINDINGS There are now four different combined oral contraceptive pills that are FDA approved for the treatment of acne since its first introduction in 1960. Recent literature has provided more information on the efficacy of different generations of combined oral contraceptive pills, their side-effects, and cancer risks. Furthermore, spironolactone has been gaining wider use among dermatologists in adolescents with endocrine dysfunction. New diagnostic guidelines and treatment recommendations have also been suggested. SUMMARY Hormonal therapies are effective and well tolerated options for the treatment of acne vulgaris in adolescents with and without endocrine disorders. They can be used as monotherapy or in conjunction with benzoyl peroxide, topical retinoic acid, or antibiotics.
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Fareau GG, Maldonado M, Oral E, Balasubramanyam A. Regression of acanthosis nigricans correlates with disappearance of anti-insulin receptor autoantibodies and achievement of euglycemia in type B insulin resistance syndrome. Metabolism 2007; 56:670-5. [PMID: 17445543 DOI: 10.1016/j.metabol.2006.12.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 12/05/2006] [Indexed: 11/28/2022]
Abstract
Autoantibodies directed against specific epitopes in the insulin receptor are rarely the cause of either recurrent hypoglycemia or a severe form of insulin resistance (type B insulin resistance). Type B insulin resistance occurs more commonly in women of African heritage and is frequently associated with a history of other autoimmune diseases. We present the unusual case of a 61-year-old African American woman with a background of autoimmune hypothyroidism and autoimmune hepatitis who developed type 2 diabetes mellitus and marked facial acanthosis nigricans (AN) over a period of weeks. Despite treatment with multiple oral antidiabetic agents, she rapidly developed severe, recalcitrant hyperglycemia and ketoacidosis, requiring hospitalization and intravenous insulin administration for 4 weeks at rates of up to 180 U/h. Immunologic testing revealed a high titer of anti-insulin receptor autoantibodies of both immunoglobulin G and immunoglobulin A classes. After a recurrence of diabetic ketoacidosis despite aggressive management, the patient was treated with a short course of cyclophosphamide; within 10 weeks, she experienced striking improvement of her hyperglycemia as well as marked regression of the AN lesions. Subsequently, the patient also experienced episodes of fasting hypoglycemia, which resolved with a brief course of glucocorticoids. She has since remained euglycemic with no therapy for 5 years. We have documented, for the first time, regression of AN in temporal association with disappearance of circulating anti-insulin receptor autoantibodies and achievement of euglycemia in a patient with type B insulin resistance.
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Affiliation(s)
- Gilbert G Fareau
- Translational Metabolism Unit, Division of Diabetes, Endocrinology, and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
BACKGROUND Acanthosis nigricans has been classified in different ways. All classifications depend on the clinical picture and the association with other conditions. OBJECTIVE We report a case of acanthosis nigricans in a patient with Kabuki syndrome. This syndrome is characterized by five main manifestations: typical facial features, post natal growth deficiency, skeletal abnormalities, dermatoglyphic abnormalities, and mild to moderate mental retardation. CONCLUSION Our case may suggest that acanthosis nigricans could be associated with Kabuki syndrome.
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Affiliation(s)
- Simone S Fahim
- Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada
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Araújo LMB, Viveiros AMCD, Lopes RC, Viana ADC, Fukui RT, Ursich MJM. Acanthosis nigricans em mulheres obesas de uma população miscigenada: um marcador de distúrbios metabólicos. An Bras Dermatol 2002. [DOI: 10.1590/s0365-05962002000500003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
FUNDAMENTOS:Acanthosis nigricans (AN) tem sido associada a diversos distúrbios metabólicos e endócrinos. OBJETIVOS: O objetivo deste estudo é avaliar a freqüência das co-morbidades da síndrome metabólica em mulheres obesas de uma população miscigenada com AN, comparada a um grupo sem AN. CASUÍSTICA E MÉTODOS: Foram estudadas 481 mulheres, consecutivamente admitidas em um ambulatório de obesidade (388 com AN e 93 sem AN) e submetidas ao teste de tolerância à glicose oral, excetuando-se 20, que já se sabiam diabéticas. RESULTADOS: A distribuição segundo a raça indicou 34,5% de brancas, 38,9% de pardas e 26,6% de negras. A freqüência global de AN foi de 80,7%, sendo fortemente maior nas negras versus brancas (90,6 % e 66,9%, p=0,000000) e negras versus pardas (86% e 90,6%, p= 0,000006). Foi também maior nas pardas versus brancas (86% e 66,9%, p<0,02). As pacientes com AN eram mais jovens (35 + 10 versus 38 + 10 anos, p < 0,01), mais obesas (41 + 6 versus 39 + 6 kg/m², p<0.01), tinham maior circunferência de cintura, maior freqüência de obesidade andróide, de diabetes tipo 2 (11,1% versus 4,3%, p=0,05), maiores níveis de insulina de jejum e de resistência insulina (Homa IR) do que aquelas sem AN. As freqüências de hipertensão diastólica e alterações do colesterol total e frações e de triglicérides entre os grupos foram similares. CONCLUSÃO: Em mulheres obesas de uma população miscigenada, AN foi mais freqüente nas de raça negra e parda e foi observada maior freqüência de co-morbidades da síndrome metabólica em comparação à população sem AN. As mulheres obesas com AN devem ser investigadas para distúrbios metabólicos, mesmo sendo jovens.
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Arioglu E, Andewelt A, Diabo C, Bell M, Taylor SI, Gorden P. Clinical course of the syndrome of autoantibodies to the insulin receptor (type B insulin resistance): a 28-year perspective. Medicine (Baltimore) 2002; 81:87-100. [PMID: 11889410 DOI: 10.1097/00005792-200203000-00001] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Elif Arioglu
- Diabetes Branch, National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland 20892-1829, USA
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Abstract
Acanthosis nigricans in obese adolescents is frequently associated with hyperinsulinemia and insulin resistance. We report three cases of this condition. In the early stage the skin lesions appeared to be erythematous and pruritic, mimicking an inflammatory dermatitis. Dietary control and oral metformin hydrochloride markedly improved the lesions. Topical calcipotriol may also help to control the skin condition.
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Affiliation(s)
- Trinh Hermanns-Lê
- Department of Dermatopathology, University Medical Center of Liège, Liège, Belgium
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