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Fu Z, Zeng J, Zhu L, Wang G, Li P, Li W, Song Z, Su Z, Sun X, Tang H, Luo P, Tan L, Gao L, Wang D, Yan S, Zhou L, Tong X, Tang Z, Zhang H, Tan W, Lu J, Zhu S. Clinical factors associated with remission of obese acanthosis nigricans after laparoscopic sleeve gastrectomy: a prospective cohort study. Int J Surg 2023; 109:3944-3953. [PMID: 37678289 PMCID: PMC10720823 DOI: 10.1097/js9.0000000000000693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Acanthosis nigricans (AN) involves skin hyperpigmentation in body folds and creases. Obesity-associated AN (OB_AN) is the most common type of AN. The skin condition of obese patients with AN can be improved through bariatric surgery, such as laparoscopic sleeve gastrectomy (LSG), after weight loss. However, the contributing factors to the remission of AN after surgery are still not fully determined. The authors aimed to assess the metabolic and pathological factors associated with remission of AN following LSG in obese individuals. METHODS The study included 319 obese patients who underwent LSG at our hospital. The subjects were divided into obesity (OB) only (OB, n =178) or OB with AN (OB_AN, n =141) groups. The basic clinical and metabolic indices and the dermatological features via reflectance confocal microscopy and histology were collected from patients prior to and after LSG. RESULTS OB_AN patients had higher fasting plasma glucose, homeostatic model assessment for insulin resistance, and testosterone levels than OB patients. LSG could significantly improve the biochemical and histopathological features of OB_AN patients. The remissive rate of OB_AN patients was about 86.5% (122 out of 141) after surgery. The remission of OB_AN skin lesions was positively correlated with testosterone levels ( P <0.01). In addition, there was a significant positive correlation between changes in AN scores and epidermal thickness and skin pigmentation scores after surgery ( P <0.01). CONCLUSION The remissive rate of OB_AN after LSG is associated with improved testosterone levels and reduced epidermal thickness and skin pigmentation levels.
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Affiliation(s)
- Zhibing Fu
- Department of General Surgery
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Jinrong Zeng
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | | | | | | | | | | | | | | | | | | | - Lina Tan
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Lihua Gao
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Dan Wang
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Siyu Yan
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Lu Zhou
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Xiaoliao Tong
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Zhen Tang
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Hanyi Zhang
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
| | - Wenbin Tan
- Department of Cell Biology and Anatomy, School of Medicine
- Department of Biomedical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina, USA
| | - Jianyun Lu
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, Hunan Province, People’s Republic of China
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Brierley GV, Semple RK. Insulin at 100 years - is rebalancing its action key to fighting obesity-related disease? Dis Model Mech 2021; 14:273551. [PMID: 34841432 PMCID: PMC8649170 DOI: 10.1242/dmm.049340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
One hundred years ago, insulin was purified and administered to people with diabetes to lower blood glucose, suppress ketogenesis and save lives. A century later, insulin resistance (IR) lies at the heart of the obesity-related disease pandemic. Multiple observations attest that IR syndrome is an amalgamation of gain and loss of insulin action, suggesting that IR is a misnomer. This misapprehension is reinforced by shortcomings in common model systems and is particularly pronounced for the tissue growth disorders associated with IR. It is necessary to move away from conceptualisation of IR as a pure state of impaired insulin action and to appreciate that, in the long term, insulin can harm as well as cure. The mixed state of gain and loss of insulin action, and its relationship to perturbed insulin-like growth factor (IGF) action, should be interrogated more fully in models recapitulating human disease. Only then may the potential of rebalancing insulin action, rather than simply increasing global insulin signalling, finally be appreciated.
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Affiliation(s)
- Gemma V Brierley
- Biomedical Research Group, School of Life Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK.,The University of Cambridge Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
| | - Robert K Semple
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, UK
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3
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Xiao TL, Duan GY, Stein SL. Retrospective review of confluent and reticulated papillomatosis in pediatric patients. Pediatr Dermatol 2021; 38:1202-1209. [PMID: 34561886 DOI: 10.1111/pde.14806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND/OBJECTIVES Confluent and reticulated papillomatosis is a skin condition with unclear etiology and limited understanding of risk factors, comorbidities, and treatment strategies in the pediatric population. This study aims to describe the varied presentations and outcomes of confluent and reticulated papillomatosis and report associated comorbidities in pediatric patients. METHODS In this retrospective single-institution case-control study, pediatric patients with a diagnosis of confluent and reticulated papillomatosis seen between 2012 and 2020 were matched approximately 1:5 with an acne vulgaris cohort based on diagnosis, setting, and time period when seen. The primary measures were the clinical features, demographics, comorbidities, treatment, and outcomes of patients with confluent and reticulated papillomatosis. Univariate and multivariable analyses were conducted to describe the association of confluent and reticulated papillomatosis with several potential risk factors and comorbidities. RESULTS Patients with confluent and reticulated papillomatosis typically presented in adolescence with a median age of 14 years and female predominance. In a multivariable analysis, patients with confluent and reticulated papillomatosis were significantly more likely to identify as Black, be overweight or obese, and have concurrent acanthosis nigricans compared to control patients. Most of the confluent and reticulated papillomatosis patients were treated with oral minocycline or doxycycline. Although all patients who received antibiotics responded to treatment, approximately half presented with recurrence, typically within 1-2 years of first treatment. CONCLUSIONS Confluent and reticulated papillomatosis is a disorder that presents in adolescence and appears to be more frequent in patients who are Black, obese, or overweight, and also have acanthosis nigricans. Clinicians should assess patients with confluent and reticulated papillomatosis for comorbidities, particularly those associated with insulin resistance, which may help reduce long-term disease burden.
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Affiliation(s)
- Teresa L Xiao
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Grace Y Duan
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Sarah L Stein
- Section of Dermatology, Department of Medicine and Pediatrics, University of Chicago Medical Center, Chicago, IL, USA
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4
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Das A, Datta D, Kassir M, Wollina U, Galadari H, Lotti T, Jafferany M, Grabbe S, Goldust M. Acanthosis nigricans: A review. J Cosmet Dermatol 2021; 19:1857-1865. [PMID: 32516476 DOI: 10.1111/jocd.13544] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acanthosis nigricans (AN) is a cutaneous disorder characterized by symmetric velvety hyperpigmented plaques on intertriginous areas like axilla, neck, inframammary, and groin. AIMS To summarize the pathophysiology and classification of AN, provide an update of diagnostic testing strategies, and describe the current therapeutic options described so far in the literature for this disease. METHODS A comprehensive english language literature search across multiple databases (PubMed, EMBASE, MEDLINE, and Cochrane) for keywords (alone and in combination) was performed. MeSH as well as non-MeSH terms such as "acanthosis nigricans," "classification," "pathophysiology," "diagnosis," "treatment," "topical drugs," "systemic drugs," "chemical peeling," and "lasers" were taken into consideration. RESULTS The pathophysiology of AN revolves around a multifactorial stimulation of proliferation of epidermal keratinocytes and dermal fibroblasts. Various types of AN include benign, obesity-associated, syndromic, malignant, acral, unilateral, medication-induced, and mixed-type. Homeostasis model assessment-insulin resistance (HOMA-IR) is a good tool for assessment of insulin resistance. Management involves general measures (weight reduction and addressing the underlying cause, if any), topical drugs (retinoids, vitamin D analogs, and keratolytics), oral drugs (retinoids and insulin sensitizers), chemical peels (trichloroacetic acid), and lasers (Long pulsed alexandrite, fractional 1550-nm erbium fiber, and CO2 ). CONCLUSION Acanthosis nigricans is a treatable condition; however, complete cure and disappearance of lesions are difficult to achieve. Weight reduction is the most scientific and practical management strategy. Long-term studies and further research is warranted in the pathophysiology and treatment of this common condition.
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Affiliation(s)
- Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, India
| | | | | | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Torello Lotti
- University of Studies Guglielmo Marconi, Rome, Italy
| | | | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
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5
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Schmidt MF, Schaller M, Schmitt LC. [Hyperplasia-associated cutaneous paraneoplasia]. Hautarzt 2021; 72:295-298. [PMID: 33660024 DOI: 10.1007/s00105-021-04777-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hyperplasia-associated cutaneous paraneoplasia is an important differential diagnosis in everyday clinical practice. An early diagnosis of the underlying tumor disease can significantly improve the patient's prognosis. PATHOGENESIS Hyperplasia is probably mainly cytokine-mediated. The primary tumor and/or the metastases release growth factors and transcription factors which, via epidermal growth factors, lead to hyperproliferation of keratinocytes. ACANTHOSIS NIGRICANS MALIGNA Symmetrical mainly intertriginous hyperpigmentation with partially verrucous hyperplasia and lichenification mostly in association with gastric adenocarcinoma. Special forms are florid cutaneous papillomatosis and tripe palms. Pseudoacanthosis nigricans is to be distinguished (metabolic and hormonal disorders). LESER-TRéLAT SYNDROME: Eruptive occurrence of seborrheic keratosis associated with visceral tumors. ACROKERATOSIS BAZEX Erythema and scaling initially at the bridge of the nose, ear helix and acra with later spread, associated with tumors of the upper aerodigestive system. It should be clinically differentiated from psoriasis. THERAPY The treatment of the primary tumor is decisive, which also leads to a decrease of cutaneous symptoms. Reappreance suggests tumor recurrence.
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Affiliation(s)
- Morna F Schmidt
- Klinik für Dermatologie und Allergologie, Hautklinik, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Martin Schaller
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Laurenz C Schmitt
- Klinik für Dermatologie und Allergologie, Hautklinik, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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6
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Cotter C, Walsh S. Cutaneous sequelae of a national health crisis: Obesity and the skin. SKIN HEALTH AND DISEASE 2021; 1:e7. [PMID: 35664818 PMCID: PMC9060079 DOI: 10.1002/ski2.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023]
Abstract
Background The global obesity pandemic has far‐reaching health consequences and has become a major global health challenge. The worldwide prevalence of obesity nearly doubled between 1980 and 2008 and based on the latest estimates in the European Union, obesity affects up to 30% of adults. As a consequence of this rising prevalence of obesity, there has been an increase in the frequency of certain disease of the skin. Objectives We review the cutaneous sequelae of obesity, firstly describing the physiological consequences of increased adiposity in the skin and secondly examining the dermatoses associated with obesity.
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Affiliation(s)
- C Cotter
- Department of Dermatology King's College Hospital NHS Foundation Trust London UK
| | - S Walsh
- Department of Dermatology King's College Hospital NHS Foundation Trust London UK
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7
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Chronic Systemic Inflammatory Skin Disease as a Risk Factor for Cardiovascular Disease. Curr Probl Cardiol 2021; 46:100799. [PMID: 33607473 DOI: 10.1016/j.cpcardiol.2021.100799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/10/2021] [Indexed: 11/24/2022]
Abstract
Chronic systemic skin disease and cardiovascular disease are multisystem disorders which have been associated with each other for centuries. Recent research has strengthened this association, particularly in systemic inflammatory disease. Here we explore the current literature on psoriasis, hidradenitis suppurativa, lupus erythematosus, acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. Psoriasis is a chronic inflammatory disorder that has been labeled as a risk-modifier for hyperlipidemia and coronary artery disease by the American College of Cardiology ACC lipid guidelines. Cardiovascular disease is also found at a significantly higher rate in patients with hidradenitis suppurativa and lupus erythematosus. Some associations have even been noted between cardiovascular disease and acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. While many of these associations have been attributed to a shared underlying disease process such as chronic systemic inflammation and shared underlying risk factors, these dermatologic manifestations can help to identify patients at higher risk for cardiovascular disease.
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8
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Kumar SV, Sudevan R, Sunny C, Sunand N, Vasudevan A, Sonu KS, Apsy PV. Prevalence of acanthosis nigricans and its association with physical activity in adolescents – School-based analytical cross-sectional study from Kochi, Kerala. J Family Med Prim Care 2021; 10:4218-4222. [PMID: 35136792 PMCID: PMC8797089 DOI: 10.4103/jfmpc.jfmpc_953_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/15/2021] [Accepted: 07/30/2021] [Indexed: 11/04/2022] Open
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9
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Coerdt KM, Todd SP, DeKlotz CMC. Topical rapamycin for acanthosis nigricans in the Fitzpatrick IV/V adolescent population. Pediatr Dermatol 2021; 38:296-298. [PMID: 33099783 DOI: 10.1111/pde.14404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dermatologically, FGFR3 mutations can lead to acanthosis nigricans (AN), epidermal nevi, and seborrheic keratosis. A recent case report found that topical rapamycin (sirolimus) can improve FGFR3-induced epidermal nevi with AN features in children, specifically with Fitzpatrick skin type (FST) I/II, and we would like to expand these findings to skin plaques with extensive AN-like features in the FST IV/V adolescent population. An 18-year-old female with FST IV/V and FGFR3-induced hypochondroplasia presented to our clinic with extensive AN-like plaques. Significant improvement with lightening and thinning of the plaques was observed after applying 1% topical rapamycin cream twice daily. Topical rapamycin should be considered as a treatment option for AN, particularly in FST IV/V adolescents with FGFR3-induced AN.
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Affiliation(s)
| | - Sarah P Todd
- Department of Dermatology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Cynthia M C DeKlotz
- Georgetown University School of Medicine, Washington, DC, USA.,Department of Dermatology, MedStar Georgetown University Hospital, Washington, DC, USA
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10
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Crouzon Syndrome and Acanthosis Nigricans With Fibrous Dysplasia of the Maxilla: An Unreported Suggested Triad. J Craniofac Surg 2020; 32:310-312. [PMID: 33156176 DOI: 10.1097/scs.0000000000007095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The aim of this report is to describe the combination of Crouzon syndrome and acanthosis nigricans with fibrous dysplasia of the maxilla. The diagnosis of fibrous dysplasia was confirmed clinically and pathologically during Le Fort III osteotomy and midface advancement with distraction osteogenesis. Crouzon syndrome with acanthosis nigricans is a known syndrome with an incidence of 1:1,000,000. This is the first report in the literature of Crouzon syndrome and acanthosis nigricans combined with fibrous dysplasia. As all 3 pathologies are related to fibroblasts, they may be different manifestations of malfunction of a single molecular pathway. The detection of fibrous dysplasia in a patient with Crouzon syndrome and acanthosis nigricans is important because it may complicate midface osteotomies and fixation of the hardware on the bones during craniofacial surgery.
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11
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Iacovelli A, Mezzaroma I, Di Paolo M, Soda G, De Vincentiis L, Palange P. A case of acanthosis nigricans in a HIV-infected patient. BMC Infect Dis 2020; 20:360. [PMID: 32434484 PMCID: PMC7238735 DOI: 10.1186/s12879-020-05089-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/13/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Alessandra Iacovelli
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
| | - Ivano Mezzaroma
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Marcello Di Paolo
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Soda
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Paolo Palange
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
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12
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Hirt PA, Castillo DE, Yosipovitch G, Keri JE. Skin changes in the obese patient. J Am Acad Dermatol 2019; 81:1037-1057. [DOI: 10.1016/j.jaad.2018.12.070] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022]
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13
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Keller JJ, Fett NM, Morrison LH. Dermatology in the Diagnosis of Noncutaneous Malignancy. Dermatol Clin 2019; 37:537-544. [DOI: 10.1016/j.det.2019.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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14
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Qiu CC, Brown AE, Lobitz GR, Shanker A, Hsu S. The color of skin: black diseases of the skin, nails, and mucosa. Clin Dermatol 2019; 37:447-467. [PMID: 31896402 DOI: 10.1016/j.clindermatol.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gradations in skin color are a consequence of differing amounts of melanin and their varying distribution. Although many darkly pigmented skin lesions are melanocytic and can be attributed to melanin content, the color of a black lesion can also be due to blood, necrotic tissue, or exogenous pigment. The source, pattern, and distribution of the color in black lesions usually offer important insight into its etiology. This contribution reviews conditions that can take on a black color, discussing the cause of the hue and any additional impact sun exposure may have.
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Affiliation(s)
- Connie C Qiu
- Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA.
| | - Ashley E Brown
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Gabriella R Lobitz
- Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Akshay Shanker
- Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
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15
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Dodds M, Maguiness S. Topical sirolimus therapy for epidermal nevus with features of acanthosis nigricans. Pediatr Dermatol 2019; 36:554-555. [PMID: 30983034 DOI: 10.1111/pde.13833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We present a 4-year-old developmentally appropriate boy with short stature and widespread expanding epidermal nevus with features of acanthosis nigricans. He was found to have a mosaic mutation in FGFR3, the R248C variant. Despite several therapies, he continued to have growth, fissuring, and bleeding of the affected skin. Ultimately, topical sirolimus was attempted and found to improve thickness and overall symptoms.
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Affiliation(s)
- Melissa Dodds
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Sheilagh Maguiness
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, Minnesota
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16
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Popa ML, Popa AC, Tanase C, Gheorghisan-Galateanu AA. Acanthosis nigricans: To be or not to be afraid. Oncol Lett 2019; 17:4133-4138. [PMID: 30944606 PMCID: PMC6444334 DOI: 10.3892/ol.2018.9736] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022] Open
Abstract
Acanthosis nigricans (AN), a skin disorder with high prevalence, represents a dermatological condition with esthetic implications, but otherwise mild symptoms. For any clinician, it is in fact the tip of the iceberg, leading him/her to investigate what lies beneath the surface, since AN points to a systemic problem or disease: metabolic disorder (most frequently), endocrine syndrome, medication side effects, malignancy, and genetic factors. Sometimes, it is the first observed sign of a malignancy or of diabetes mellitus, especially in patients with chronic metabolic disorder; therefore, it is not to be taken lightly. The present review summarizes the information in literature regarding the etiopathogenesis of AN. We propose a new classification that aims to better organize the different types of AN, with implications on the extent and urgency of the investigation plan, as well as various therapeutic algorithms. Therapy options are also presented, both systemic treatments that target the underlying disease, and local ones for esthetic reasons.
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Affiliation(s)
- Maria-Linda Popa
- Department of Cellular and Molecular Biology and Histology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Biochemistry-Proteomics, ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania
| | | | - Cristiana Tanase
- Department of Biochemistry-Proteomics, ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania
| | - Ancuta-Augustina Gheorghisan-Galateanu
- Department of Cellular and Molecular Biology and Histology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- ‘C.I. Parhon’ National Institute of Endocrinology, 001863 Bucharest, Romania
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17
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Arellano J, Iglesias P, Suarez C, Corredoira Y, Schnettler K. Malignant acanthosis nigricans as a paraneoplastic manifestation of metastatic breast cancer. Int J Womens Dermatol 2019; 5:183-186. [PMID: 31360756 PMCID: PMC6637086 DOI: 10.1016/j.ijwd.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/01/2019] [Accepted: 03/13/2019] [Indexed: 10/30/2022] Open
Abstract
Malignant acanthosis nigricans is a rare paraneoplastic syndrome, usually associated with a gastric adenocarcinoma and less frequently with other neoplasms. In general, its appearance indicates a poor prognosis with a survival of < 2 years. We describe the case of a 40-year-old patient who presented with generalized cutaneous thickening that had a velvety appearance, was rapidly progressing, and involved right axillary adenopathy. Skin and nipple biopsy yielded results consistent with acanthosis nigricans, and palpable adenopathy biopsy results were compatible with mammary adenocarcinoma (human epidermal growth factor receptor 2 positive and estrogen and progesterone receptor negative) without a detectable primary tumor. This case of malignant acanthosis nigricans is presented because of the importance of its early recognition as a paraneoplastic syndrome and its relation with mammary adenocarcinoma, an association infrequently reported in the literature.
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Affiliation(s)
- Javier Arellano
- Department of Dermatology, University of Chile, Santiago, Chile.,Department of Dermatology, Hospital Clínico San Borja, Arriarán, Chile
| | - Pamela Iglesias
- Department of Dermatology, University of Chile, Santiago, Chile
| | - Claudia Suarez
- Department of Dermatology, University of Chile, Santiago, Chile
| | - Yamile Corredoira
- Department of Pathology, University of Chile, Santiago, Chile.,Department of Pathology, Hospital Clínico San Borja, Arriarán, Chile
| | - Katty Schnettler
- Department of Pathology, Hospital Clínico San Borja, Arriarán, Chile
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18
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Abstract
Polycystic ovarian syndrome is an endocrine disorder diagnosed commonly in young women. Various cutaneous manifestations can include acanthosis nigricans, acne, hirsutism, and alopecia. Confluent and reticulated papillomatosis is a rare skin condition that may be associated with polycystic ovarian syndrome. The etiology of confluent and reticulated papillomatosis is not yet well established but multiple theories exist regarding its pathogenesis. We describe a woman with established polycystic ovarian syndrome who presented with confluent and reticulated papillomatosis; her skin condition was successfully treated with azithromycin. The clinical features, differential diagnosis, epidemiology, and proposed etiologies for confluent and reticulated papillomatosis are discussed as well as possible treatment options. Among women with polycystic ovarian syndrome, confluent and reticulated papillomatosis and acanthosis nigricans can occur concurrently. Additionally, it is possible that confluent and reticulated papillomatosis occurs more commonly in this patient population.
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Affiliation(s)
- Pallavi Basu
- Dermatology, University of California, San Diego, USA
| | - Philip R Cohen
- Dermatology, San Diego Family Dermatology, San Diego, USA
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19
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Fu J, Zhao Y, Wang T, Zhang Q, Xiao X. Acanthosis nigricans in a Chinese girl with FGFR3 K650 T mutation: a case report and literature review. BMC MEDICAL GENETICS 2019; 20:8. [PMID: 30635042 PMCID: PMC6329052 DOI: 10.1186/s12881-019-0748-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/07/2019] [Indexed: 01/09/2023]
Abstract
Background Acanthosis nigricans (AN) is a clinical manifestation featured by velvety brown plaques in skin folds that occurs in some hereditary and syndromic disorders. Fibroblast growth factor receptor 3 (FGFR3) mutations have been identified as one of the genetic causes of inherited AN. Case presentation A 17-year-old Chinese female had presented generalized acanthosis nigricans since she was 4 years old. She yielded no family history of short stature or AN. Apart from a short stature, no skeletal defects, neurological defects or other abnormalities were found. To identify the aetiology of the clinically diagnosed AN, we screened the proband for genetic mutations using whole exome sequencing. A heterozygous mutation (c.1949A > C, p.Lys650Thr) in FGFR3 was found in the proband. To date, 26 cases of AN harbouring this specific gene mutation have been reported in the literature, and only one child carried a de novo mutation instead of inheriting the specific mutation from their parents. The present case is the first-reported Chinese patient with isolated AN with a de novo K650 T mutation in FGFR3. Conclusions We reported a new case of AN caused by a heterozygous mutation (c.1949A > C, p.K650 T) in FGFR3, and review the past reports of AN with the same gene mutation. Sequencing of the FGFR3 gene is a feasible approach to identify the aetiology of AN, especially for early onset extensive AN. Electronic supplementary material The online version of this article (10.1186/s12881-019-0748-4) contains supplementary material, which is available to authorized users. Electronic supplementary material The online version of this article (10.1186/s12881-019-0748-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Junling Fu
- Department of Endocrinology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Yiting Zhao
- Department of Center of PET-CT, Chinese Academy of Medical Sciences Cancer Institute and Hospital, Beijing, 100021, China
| | - Tong Wang
- Department of Endocrinology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Qian Zhang
- Department of Endocrinology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Xinhua Xiao
- Department of Endocrinology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China.
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20
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Abstract
Achondroplasia is the most common of the skeletal dysplasias that result in marked short stature (dwarfism). Although its clinical and radiologic phenotype has been described for more than 50 years, there is still a great deal to be learned about the medical issues that arise secondary to this diagnosis, the manner in which these are best diagnosed and addressed, and whether preventive strategies can ameliorate the problems that can compromise the health and well being of affected individuals. This review provides both an updated discussion of the care needs of those with achondroplasia and an exploration of the limits of evidence that is available regarding care recommendations, controversies that are currently present, and the many areas of ignorance that remain.
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Affiliation(s)
- Richard M Pauli
- Midwest Regional Bone Dysplasia Clinic, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 1500 Highland Ave., Madison, WI, 53705, USA.
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21
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Smid CJ, Modaff P, Alade A, Legare JM, Pauli RM. Acanthosis nigricans in achondroplasia. Am J Med Genet A 2018; 176:2630-2636. [PMID: 30380187 DOI: 10.1002/ajmg.a.40506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 06/19/2018] [Accepted: 07/23/2018] [Indexed: 12/24/2022]
Abstract
Acanthosis nigricans (AN) in those with achondroplasia has been reported occasionally in the literature previously. Other disorders arising from constitutive activation of FGFR3 also manifest AN at various frequencies. We assessed the prevalence of AN in a sequential series of 477 individuals with achondroplasia. Using a REDCap database, we collected and analyzed what other features or medical issues may co-occur with AN in those with achondroplasia. AN arises in approximately 10% of individuals with achondroplasia. It usually first appears in preadolescence or adolescence, is more likely in the non-White population and in those who are obese. It is not severe and generally will need no treatment. It is not associated with any evident risk for neither hyperinsulinemic states nor malignancy, and therefore, no special investigations are warranted when it is recognized. Thus, clinicians should not be surprised or concerned upon discovering this finding in those with achondroplasia. In addition, the mechanisms and genetic causes of AN are detailed.
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Affiliation(s)
- Cory J Smid
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peggy Modaff
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Midwest Regional Bone Dysplasia Clinic, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Adekemi Alade
- Greenberg Center for Skeletal Dysplasias, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Janet M Legare
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Midwest Regional Bone Dysplasia Clinic, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Richard M Pauli
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.,Midwest Regional Bone Dysplasia Clinic, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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22
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Hirai H, Hamada J, Hasegawa K, Ishii E. Acanthosis nigricans in a Japanese boy with hypochondroplasia due to a K650T mutation in FGFR3. Clin Pediatr Endocrinol 2017; 26:223-228. [PMID: 29026271 PMCID: PMC5627223 DOI: 10.1297/cpe.26.223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/27/2017] [Indexed: 12/27/2022] Open
Abstract
Acanthosis nigricans (AN) is observed in some cases of skeletal dysplasia. However, AN
has occasionally been reported in patients with hypochondroplasia (HCH), and a clinical
diagnosis is sometimes difficult when its physical and radiological features are mild.
Mutations in the gene encoding the fibroblast growth factor receptor 3
(FGFR3) have been identified as the cause of some types of skeletal
dysplasia, which is diagnostically useful. Here, we report the case of a 3-yr-old Japanese
boy who presented with AN. His height, weight, head circumference, and arm span were 91.7
cm (–1.95 SD), 16.3 kg, 54.0 cm (+2.6 SD), and 88.0 cm, respectively. In addition to the
AN, he also exhibited a mild height deficit and macrocephaly, which prompted a search for
FGFR3 mutations, although no skeletal disproportion, exaggerated lumbar
lordosis, or facial dysmorphism was observed, and only slight radiological abnormalities
were noted. A definitive diagnosis of HCH was made based on FGFR3 gene
analysis, which detected a heterozygous K650T mutation. Insulin insensitivity was not
found to have contributed to the development of AN. In individuals with AN, careful
assessments for symptoms of HCH are important, regardless of the presence or absence of a
short stature, and FGFR3 gene analysis is recommended in such cases.
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Affiliation(s)
- Hiroki Hirai
- Division of Pediatrics, Shikoku Central Hospital, Ehime, Japan.,Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Junpei Hamada
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kosei Hasegawa
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan
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23
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Fukumoto T, Kozaru T, Sakaguchi M, Oka M. Concomitant confluent and reticulated papillomatosis and acanthosis nigricans in an obese girl with insulin resistance successfully treated with oral minocycline: Case report and published work review. J Dermatol 2017; 44:954-958. [DOI: 10.1111/1346-8138.13819] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Takeshi Fukumoto
- Division of Dermatology; Department of Internal Related; Kobe University Graduate School of Medicine; Kobe Japan
| | - Takeshi Kozaru
- Division of Dermatology; Department of Internal Related; Kobe University Graduate School of Medicine; Kobe Japan
| | - Masanobu Sakaguchi
- Division of Dermatology; Department of Internal Related; Kobe University Graduate School of Medicine; Kobe Japan
- Division of Dermatology; Tohoku Medical and Pharmaceutical University; Sendai Japan
| | - Masahiro Oka
- Division of Dermatology; Department of Internal Related; Kobe University Graduate School of Medicine; Kobe Japan
- Division of Dermatology; Tohoku Medical and Pharmaceutical University; Sendai Japan
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24
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Gorlanov IA, Zaslavskiy DV, Leina LM, Milyavskaya IR. Obesity related skin disorders. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-6-20-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Obesity is a serious global problem. In recent years, it has been an increase in patients with obesity. In a review of literature presents data on the effect of obesity on the skin. It is responsible for the development of a number of dermatological diseases, including acantosis nigricans, akrohordony, follicular hyperkeratosis, infectious diseases of the skin. Against the background of obesity worsens psoriasis. The connection between obesity and atopic dermatitis.
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25
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Moreno-Artero E, Querol E, Ivars M, Sola I, Pío R, España A. Assessment of EGF receptor ligand expression in gastric carcinoma and in lesional skin of paraneoplastic acanthosis nigricans: a case report. J Eur Acad Dermatol Venereol 2016; 31:e301-e302. [PMID: 27987313 DOI: 10.1111/jdv.14087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E Moreno-Artero
- Department of Dermatology, School of Medicine, University Clinic of Navarra, University of Navarra, IdiSNA, Navarra Institute for Health Research, PO Box 4209, Pamplona, Navarra, Spain
| | - E Querol
- Department of Dermatology, School of Medicine, University Clinic of Navarra, University of Navarra, IdiSNA, Navarra Institute for Health Research, PO Box 4209, Pamplona, Navarra, Spain
| | - M Ivars
- Department of Dermatology, School of Medicine, University Clinic of Navarra, University of Navarra, IdiSNA, Navarra Institute for Health Research, PO Box 4209, Pamplona, Navarra, Spain
| | - I Sola
- Department of Pathology, University Clinic of Navarra, University of Navarra, IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | - R Pío
- Program in Solid Tumors and Biomarkers - CIMA (Center for Applied Medical Research), University Clinic of Navarra, University of Navarra, IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | - A España
- Department of Dermatology, School of Medicine, University Clinic of Navarra, University of Navarra, IdiSNA, Navarra Institute for Health Research, PO Box 4209, Pamplona, Navarra, Spain
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26
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Demirci K, Bilen N, Şikar Aktürk A, Odyakmaz Demirsoy E, Cantürk Z, Çağlayan Ç, Bayramgüler D, Kıran R. Erişkin Obez Hastalarda Dermatolojik Bulgular. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2016. [DOI: 10.30934/kusbed.358623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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27
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Kanaka-Gantenbein C, Kogia C, Abdel-Naser MB, Chrousos GP. Skin manifestations of growth hormone-induced diseases. Rev Endocr Metab Disord 2016; 17:259-267. [PMID: 27571787 DOI: 10.1007/s11154-016-9378-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The human skin is a well-organized organ bearing different types of cells in a well-structured interference to each other including epidermal and follicular keratinocytes, sebocytes, melanocytes, dermal papilla cells and fibroblasts, endothelial cells, sweat gland cells as well as nerves. Several hormones act on different cell types of the skin, while it is also considered an endocrine organ secreting hormones that act at several sites of the organism. GH receptors are found in almost all cell types forming the skin, while IGF-1 receptors' expression is restricted to the epidermal keratinocytes. Both Growth Hormone (GH) excess, as in the case of Acromegaly in adults, or Gigantism in growing children, and GH deficiency states lead to skin manifestations. In case of GH excess the main dermatological findings are skin thickening, coarsening of facial features, acrochordons, puffy hands and feet, oily skin and hyperhidrosis, while GH deficiency, on the contrary, is characterized by thin, dry skin and disorder of normal sweating. Moreover, special disorders associated with GH excess may have specific characteristics, as is the case of café-au-lait spots in Neurofibromatosis, or big café-au-lait skin hyperpigmented regions with irregular margins, as is the case in McCune-Albright syndrome. Meticulous examination of the skin may therefore contribute to the final diagnosis in cases of GH-induced disorders.
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Affiliation(s)
- Christina Kanaka-Gantenbein
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Christina Kogia
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamed Badawy Abdel-Naser
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - George P Chrousos
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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28
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Woo YR, Lim JH, Kim M, Park HJ. Linear acanthosis nigricans on the anterior neck: Koebner phenomenon observed in a patient with acanthosis nigricans. J Dermatol 2016; 44:843-845. [PMID: 27569660 DOI: 10.1111/1346-8138.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yu Ri Woo
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hong Lim
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Miri Kim
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jeong Park
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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29
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[Clinicopathological aspects of terra firma-forme dermatosis]. Ann Dermatol Venereol 2016; 143:446-52. [PMID: 27062007 DOI: 10.1016/j.annder.2016.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/01/2015] [Accepted: 02/19/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Terra firma-forme dermatosis was first described in 1987. It is characterized by the appearance in children or adolescents of dirt-like patches despite normal cleansing. The lesions are removed when the skin is rubbed with a 70°C alcohol swab. This largely unknown condition is of uncertain origin but could be due to a keratinisation disorder. PATIENTS AND METHODS Herein we report the case of a 17-year-old male patient who, after seeking the opinions of a number of doctors, consulted in dermatology for multiple pigmented patches on the trunk and limbs that had appeared one year earlier. These lesions had persisted despite appropriate cleansing. He had no history of endocrine disorders and no familial history of pigmentation disorders. A skin biopsy revealed compact orthokeratotic hyperkeratosis resembling a second layer of stratum corneum on top of a normal layer. Very small granules were seen within this layer and PAS staining revealed spores. These skin lesions disappeared when rubbed with an alcohol swab, resulting in a diagnosis of terra firma-forme dermatosis. DISCUSSION Where a diagnosis of terra firma-forme dermatosis is suspected, confirmation is easy to obtain using an alcohol swab. Nevertheless, the disease is not familiar to dermatologists. The most common differential diagnoses are acanthosis nigricans, reticulate and confluent papillomatosis, and Dowling-Degos disease. Their histopathological appearances are very different and skin biopsy can be useful for diagnosis. These entities belong to a group of disorders involving abnormal keratinisation and pigmentation. Anatomoclinical correlation is essential for optimal management. The appearance of the stratum corneum may play an important role in the diagnosis of terra firma-forme dermatosis.
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30
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Kutlubay Z, Engin B, Bairamov O, Tüzün Y. Acanthosis nigricans: A fold (intertriginous) dermatosis. Clin Dermatol 2015; 33:466-70. [PMID: 26051063 DOI: 10.1016/j.clindermatol.2015.04.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acanthosis nigricans (AN) is a mucocutaneous disorder that is characterized by focal or diffuse hyperkeratotic, surfaces, which are symmetrically distributed hyperpigmented lesions of the skin. It rarely affects mucosal surfaces like oral cavities. Although it is commonly seen in adolescents, AN is also increasingly seen in children who are obese. Recent studies have found that AN can be a cutaneous indicator of insulin resistance and malignancy. Acanthosis nigricans has been associated with type 2 diabetes mellitus, obesity, endocrinopathies, drugs, and malignancies.
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Affiliation(s)
- Zekayi Kutlubay
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University, Fatih, Istanbul 34098, Turkey.
| | - Burhan Engin
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University, Fatih, Istanbul 34098, Turkey
| | - Orkhan Bairamov
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University, Fatih, Istanbul 34098, Turkey
| | - Yalçın Tüzün
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University, Fatih, Istanbul 34098, Turkey
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31
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Hypochondroplasia, Acanthosis Nigricans, and Insulin Resistance in a Child with FGFR3 Mutation: Is It Just an Association? Case Rep Endocrinol 2014; 2014:840492. [PMID: 25505998 PMCID: PMC4255054 DOI: 10.1155/2014/840492] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/28/2014] [Accepted: 10/30/2014] [Indexed: 12/19/2022] Open
Abstract
FGFR3 mutations cause wide spectrum of disorders ranging from skeletal dysplasias (hypochondroplasia, achondroplasia, and thanatophoric dysplasia), benign skin tumors (epidermal nevi, seborrhaeic keratosis, and acanthosis nigricans), and epithelial malignancies (multiple myeloma and prostate and bladder carcinoma). Hypochondroplasia is the most common type of short-limb dwarfism in children resulting from fibroblast growth factor receptor 3 (FGFR3) mutation. Acanthosis nigricans might be seen in severe skeletal dysplasia, including thanatophoric dysplasia and SADDAN syndrome, without a biochemical evidence of hyperinsulinemia. Insulin insensitivity and acanthosis nigricans are uncommonly seen in hypochondroplasia patients with FGFR3 mutations which may represent a new association. We aim to describe the association of hypochondroplasia, acanthosis nigricans, and insulin resistance in a child harboring FGFR3 mutation. To our knowledge, this is the first case report associating the p.N540 with acanthosis nigricans and the second to describe hyperinsulinemia in hypochondroplasia. This finding demonstrates the possible coexistence of insulin insensitivity and acanthosis nigricans in hypochondroplasia patients.
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32
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Kubicka-Wołkowska J, Dębska-Szmich S, Lisik-Habib M, Noweta M, Potemski P. Malignant acanthosis nigricans associated with prostate cancer: a case report. BMC Urol 2014; 14:88. [PMID: 25399333 PMCID: PMC4239373 DOI: 10.1186/1471-2490-14-88] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 10/29/2014] [Indexed: 12/17/2022] Open
Abstract
Background Acanthosis nigricans is characterized by hyperpigmentation and hyperkeratosis of the skin or mucous membranes. Its malignant form is associated with internal neoplasms, especially gastric adenocarcinoma (55–61%). Coexistence with prostate cancer is uncommon. In the paraneoplastic type of this dermatosis, the skin and mucous lesions are characteristically of more sudden onset and more severe than those in the benign form. The efficacy of various treatment strategies remains disappointing. Case presentation We here report a case of 66-year-old Caucasian patient with metastatic prostate cancer and a mild form of acanthosis nigricans that preceded the diagnosis of malignancy and resolved with chemotherapy in parallel with the prostate cancer. The dermatosis recurred when the prostate cancer progressed. Conclusion Concurrent acanthosis nigricans and prostate cancer is rare, and few such cases have been reported. Anti-tumor therapy occasionally results in regression of this dermatosis. Underlying malignant disease should be suspected in individuals with elderly-onset of acanthosis nigricans.
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33
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Lagaude M, Barreau M, Jokic M, Gerard M, DiRocco F, Hadj-Rabia S, Dompmartin A, Verneuil L. Acanthosis nigricans chez l’enfant et syndrome de Crouzon. Ann Dermatol Venereol 2014; 141:685-8. [DOI: 10.1016/j.annder.2014.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/10/2014] [Accepted: 06/19/2014] [Indexed: 02/06/2023]
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34
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Abstract
Most diabetes is polygenic in etiology, with (type 1 diabetes, T1DM) or without (type 2 diabetes, T2DM) an autoimmune basis. Genetic counseling for diabetes generally focuses on providing empiric risk information based on family history and/or the effects of maternal hyperglycemia on pregnancy outcome. An estimated one to five percent of diabetes is monogenic in nature, e.g., maturity onset diabetes of the young (MODY), with molecular testing and etiology-based treatment available. However, recent studies show that most monogenic diabetes is misdiagnosed as T1DM or T2DM. While efforts are underway to increase the rate of diagnosis in the diabetes clinic, genetic counselors and clinical geneticists are in a prime position to identify monogenic cases through targeted questions during a family history combined with working in conjunction with diabetes professionals to diagnose and assure proper treatment and familial risk assessment for individuals with monogenic diabetes.
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Affiliation(s)
- Stephanie A Stein
- Department of Medicine, Division of Endocrinology, Diabetes & Nutrition, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kristin L Maloney
- Department of Medicine, Division of Endocrinology, Diabetes & Nutrition, University of Maryland School of Medicine, Baltimore, Maryland ; Program in Genetics and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Toni I Pollin
- Department of Medicine, Division of Endocrinology, Diabetes & Nutrition, University of Maryland School of Medicine, Baltimore, Maryland ; Program in Genetics and Genomic Medicine, University of Maryland School of Medicine, Baltimore, Maryland ; Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, Maryland
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35
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Schilling WHK, Crook MA. Cutaneous stigmata associated with insulin resistance and increased cardiovascular risk. Int J Dermatol 2014; 53:1062-9. [PMID: 24697530 DOI: 10.1111/ijd.12463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Certain cutaneous conditions have been reported to be associated with diabetes mellitus, insulin resistance, and metabolic syndrome. In this novel review paper, the evidence linking various cutaneous phenomena (e.g. skin tags, acanthosis nigricans, ear lobe creases, and xanthelasma) and metabolic syndrome and cardiovascular disease is examined, and explanations for these associations are proposed.
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Affiliation(s)
- William H K Schilling
- Clinical Biochemistry and Metabolic Medicine, University Hospital Lewisham and Guy's and St Thomas' Hospital, London, UK
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36
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Ahmad S, Mahmoudi H, Naeem M, Betz RC. Autosomal recessive isolated familial acanthosis nigricans in a Pakistani family due to a homozygous mutation in the insulin receptor gene. Br J Dermatol 2014; 169:476-8. [PMID: 23448340 DOI: 10.1111/bjd.12293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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37
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Ishigami T, Hida Y, Matsudate Y, Murao K, Kubo Y. The involvement of fibroblast growth factor receptor signaling pathways in dermatofibroma and dermatofibrosarcoma protuberans. THE JOURNAL OF MEDICAL INVESTIGATION 2014; 60:106-13. [PMID: 23614918 DOI: 10.2152/jmi.60.106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Fibroblast growth factors (FGFs) and their receptors (FGFRs) control a wide range of biological functions; however, their involvement in the pathogenesis of dermatofibroma (DF) and dermatofibrosarcoma protuberans (DFSP) is currently unknown. In this study, we first confirmed the histological diagnosis by detecting fusion COL1A1-PDGFB transcripts in DFSP, and examined the expression of all FGFRs (FGFR1-4), some of their ligands (FGF1, 2, 9), and forkhead box N1 (FOXN1) as a downstream target of FGFR3 in DF and DFSP by immunohistochemical analysis. Although we failed to detect the expression of FGF1 and FGF9 as specific ligands for FGFR3 in DF, overexpression of FGFR3 and FOXN1 was observed in the epidermal regions of DF, suggesting that the epidermal regions of DF were similar to seborrhoeic keratosis both in terms of histological features and the activation of FGFR3/FOXN1. In addition, strong expression of FGF2 and FGFR4 was observed in the tumor lesions of DF. Expression patterns of FGFR3/FOXN1 and FGF2/FGFR4 in DF were in contrast with those of DFSP. The activation of FGFR signaling pathways may be not only relevant to the pathogenesis of DF, but also very useful in the differential diagnosis of DF and DFSP.
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Affiliation(s)
- Takeshi Ishigami
- Department of Dermatology, Institute of Health Biosciences, the University of Tokushima Graduate School, Tokushima, Japan
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Murphy-Chutorian B, Han G, Cohen SR. Dermatologic manifestations of diabetes mellitus: a review. Endocrinol Metab Clin North Am 2013; 42:869-98. [PMID: 24286954 DOI: 10.1016/j.ecl.2013.07.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Diabetes mellitus affects every organ of the body including the skin. Certain skin manifestations of diabetes are considered cutaneous markers of the disease, whereas others are nonspecific conditions that occur more frequently among individuals with diabetes compared with the general population. Diabetic patients have an increased susceptibility to some bacterial and fungal skin infections, which account, in part, for poor healing. Skin complications of diabetes provide clues to current and past metabolic status. Recognition of cutaneous markers may slow disease progression and ultimately improve the overall prognosis by enabling earlier diagnosis and treatment.
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Mohanan S, Chandrashekar L, Semple RK, Thappa DM, Parameswaran N, Negi VS, Ramassamy S. Rabson-Mendenhall syndrome with recurrent cerebral infarcts caused by a novel INSR mutation. Int J Dermatol 2013; 52:182-5. [PMID: 23347304 DOI: 10.1111/j.1365-4632.2012.05665.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rabson-Mendenhall syndrome (RMS) is an autosomal recessive disorder characterized by extreme insulin resistance and certain characteristic phenotypic features. The primary defect lies in the insulin receptor and involves biallelic mutations that lead to a loss of function through various postulated defects. We present a 9-year-old female patient with RMS complicated by multiple cerebral infarcts, in whom genetic analysis revealed a novel insulin receptor mutation.
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Affiliation(s)
- Saritha Mohanan
- Department of Skin and Sexually Transmitted Diseases, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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40
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Peña Irún A. [Acral acanthosis nigricans associated with taking growth hormone]. Semergen 2013; 40:e77-9. [PMID: 23746703 DOI: 10.1016/j.semerg.2013.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Revised: 03/18/2013] [Accepted: 03/19/2013] [Indexed: 11/19/2022]
Abstract
Acanthosis nigricans is a skin lesion characterized by the presence of a hyperpigmented, velvety cutaneous thickening that usually appears in flexural areas. Less frequently, it can occur in other locations, such as the dorsum of hands and feet. In this case it is called acral acanthosis nigricans. It is a dermatological manifestation of systemic disease. It is often associated with insulin resistance-mediated endocrine diseases. A case is presented on a patient with acanthosis nigricans secondary to the use of growth hormone.
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Affiliation(s)
- A Peña Irún
- Medicina de Familia y Comunitaria, Centro de Salud Sardinero, Santander, Cantabria, España.
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41
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Costa MC, Martinez NS, Belicha MG, Leal F. Acanthosis nigricans and "tripe palm" as paraneoplastic manifestations of metastatic tumor. An Bras Dermatol 2013; 87:498-500. [PMID: 22714777 DOI: 10.1590/s0365-05962012000300030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 12/25/2011] [Indexed: 11/22/2022] Open
Abstract
Acanthosis nigricans is a common dermatosis and is most often associated with benign conditions, such as insulin resistance. It is rare as a paraneoplastic marker. As such, it is characterized by sudden onset and rapid dissemination of velvety and hyperchromic skin lesions. The term "tripe palm" refers to exaggeration of the palmar ridge pattern, which resembles the internal surface of the bovine intestinal tract. This is a paraneoplastic marker of high specificity, with 90% of the cases being associated with malignancy. We report the case of a patient with stage IV ovarian adenocarcinoma presenting acanthosis nigricans and tripe palm. Both findings are closely correlated to the neoplasm course.
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Deveci I, Sürmeli M, Senem Deveci H, Eriman M, Habesoglu M, Tek A, Misirlioglu K, Gunes P. Effects of Polycystic Ovary Syndrome and Menopause on Rat Soft Palate and Base of Tongue. Otolaryngol Head Neck Surg 2013; 148:595-601. [DOI: 10.1177/0194599812473241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To investigate the histopathologic changes in rat soft palate and base of tongue by performing experimental polycystic ovary syndrome (PCOS) and menopause models. Study Design Experimental study. Setting The study was conducted at the animal care facility of Haydarpasa Numune Education and Research Hospital. Subject and Methods Thirty healthy female Albino Wistar rats were divided into 4 groups (PCOS study group [n = 10], per oral letrozole given; PCOS control group [n = 6], per oral saline given; menopause study group [n = 8], ovariectomized; menopause control group [n = 6], sham operated). At the end of the follow-up periods, all animals were euthanized, and soft palates and base of tongues of all groups were removed to observe the histopathologic changes. Results When we compared the PCOS study group with the PCOS control group, submucous gland hypertrophy, mast cell infiltration, vascular engorgement, and acanthosis were significantly different in the soft palate ( P < .05), and in addition to these findings, lymphocyte infiltration, subepithelial edema, and dilated glandular excretory duct were significantly different in base of tongue ( P < .05). When we compared the menopause study group with the menopause control group, only vascular engorgement was significantly different in the soft palate ( P < .05), and in addition to this finding, submucous gland hypertrophy, lymphocyte infiltration, polymorphonuclear leukocyte infiltration, and subepithelial edema were significantly different in base of tongue ( P < .05). Conclusion Our findings suggest that PCOS and menopause induce significant histopathologic changes in the soft palate and base of tongue that are similar to the histopathologic changes seen in the soft palate and base of tongue of patients with obstructive sleep apnea syndrome.
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Affiliation(s)
- Ildem Deveci
- Department of Otorhinolaryngology–Head and Neck Surgery Beykoz Government Hospital, Istanbul, Turkey
| | - Mehmet Sürmeli
- Department of Otorhinolaryngology–Head and Neck Surgery, Karaman Government Hospital, Karaman, Turkey
| | - Hande Senem Deveci
- Department of Otorhinolaryngology–Head and Neck Surgery, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Murat Eriman
- Department of Otorhinolaryngology–Head and Neck Surgery, Diyarbakir Ergani Government Hospital, Diyarbakır, Turkey
| | - Mehmet Habesoglu
- Department of Otorhinolaryngology–Head and Neck Surgery, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Arman Tek
- Department of Otorhinolaryngology–Head and Neck Surgery, Tarsus Government Hospital, Mersin, Turkey
| | - Kutyar Misirlioglu
- Department of Anesthesiology and Reanimation, Seydisehir Government Hospital, Konya, Turkey
| | - Pembegul Gunes
- Department of Pathology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
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Santoro N, Amato A, Grandone A, Brienza C, Savarese P, Tartaglione N, Marzuillo P, Perrone L, Miraglia del Giudice E. Predicting metabolic syndrome in obese children and adolescents: look, measure and ask. Obes Facts 2013; 6:48-56. [PMID: 23429241 PMCID: PMC5644669 DOI: 10.1159/000348625] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 07/25/2012] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To verify in obese children whether or not the presence of (i) high waist-to-height ratio (WHtR), (ii) family history for type 2 diabetes (T2D) and (iii) acanthosis nigricans (AN), singularly or together, might predict the occurrence of metabolic syndrome or prediabetes. METHODS 1,080 Italian obese children (567 females) were enrolled. Blood pressure, fasting plasma glucose, insulin, and lipids were measured, and oral glucose tolerance test (OGTT) was performed. The WHtR was calculated, family history for T2D was assessed, and the presence of AN was noticed. The odds ratios for showing metabolic syndrome and/or prediabetes according to the presence of these features were calculated. RESULTS The prevalence of metabolic syndrome was 29.2%. AN (OR1.81; p = 0.002) and WHtR higher than 0.60 (OR 2.24; p < 0.0001) were the clinical signs linked to higher risk for showing metabolic syndrome, and the odds raised significantly when these elements occurred simultaneously (OR 3.34; p < 0.0001). T2D family history (OR 2.36; p = 0.01) and WHtR higher than 0.60 (OR 2.32; p = 0.009) were the two features associated with increased odds of showing prediabetes. CONCLUSIONS Three simple actions, i.e., looking at the patient, asking about T2D family history, and measuring WHtR, may represent a powerful tool in the hands of pediatricians to identify obese children with high cardiovascular and metabolic risk.
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Affiliation(s)
- Nicola Santoro
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Alessandra Amato
- Department of Pediatrics ‘F. Fede’ Seconda Università degli Studi di Napoli, Naples, Italia
| | - Anna Grandone
- Department of Pediatrics ‘F. Fede’ Seconda Università degli Studi di Napoli, Naples, Italia
| | - Carmine Brienza
- Department of Pediatrics ‘F. Fede’ Seconda Università degli Studi di Napoli, Naples, Italia
| | - Piera Savarese
- Department of Pediatrics ‘F. Fede’ Seconda Università degli Studi di Napoli, Naples, Italia
| | - Nunzia Tartaglione
- Department of Pediatrics ‘F. Fede’ Seconda Università degli Studi di Napoli, Naples, Italia
| | - Pierluigi Marzuillo
- Department of Pediatrics ‘F. Fede’ Seconda Università degli Studi di Napoli, Naples, Italia
| | - Laura Perrone
- Department of Pediatrics ‘F. Fede’ Seconda Università degli Studi di Napoli, Naples, Italia
| | - Emanuele Miraglia del Giudice
- Department of Pediatrics ‘F. Fede’ Seconda Università degli Studi di Napoli, Naples, Italia
- *Dr. Emanuele Miraglia del Giudic, Department of Pediatrics, Seconda Univesità di Napoli, Via L. De Crecchio no 4, 80138, Naples (Italy),
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Singh GK, Sen D, Mulajker DS, Suresh MS. Acanthosis nigricans associated with transitional cell carcinoma of the urinary bladder. Indian J Dermatol 2012; 56:722-5. [PMID: 22345779 PMCID: PMC3276905 DOI: 10.4103/0019-5154.91837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
An elderly man from the region of Ladakh presented with recurrent episodes of lower respiratory tract infection, rapidly progressive Acanthosis nigricans, Acanthosis palmaris and plantar keratoderma. Detailed investigations revealed underlying metastatic transitional cell carcinoma of the bladder. This case is being reported for its rarity in the literature.
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Affiliation(s)
- Gautam K Singh
- Department of Dermatology, Graded Specialist (Derm & Ven), Command Hospital Eastern Command, Kolkata, India
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45
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Wang Y, Zhou X, Oberoi K, Phelps R, Couwenhoven R, Sun M, Rezza A, Holmes G, Percival CJ, Friedenthal J, Krejci P, Richtsmeier JT, Huso DL, Rendl M, Jabs EW. p38 Inhibition ameliorates skin and skull abnormalities in Fgfr2 Beare-Stevenson mice. J Clin Invest 2012; 122:2153-64. [PMID: 22585574 DOI: 10.1172/jci62644] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 04/04/2012] [Indexed: 12/21/2022] Open
Abstract
Beare-Stevenson cutis gyrata syndrome (BSS) is a human genetic disorder characterized by skin and skull abnormalities. BSS is caused by mutations in the FGF receptor 2 (FGFR2), but the molecular mechanisms that induce skin and skull abnormalities are unclear. We developed a mouse model of BSS harboring a FGFR2 Y394C mutation and identified p38 MAPK as an important signaling pathway mediating these abnormalities. Fgfr2+/Y394C mice exhibited epidermal hyperplasia and premature closure of cranial sutures (craniosynostosis) due to abnormal cell proliferation and differentiation. We found ligand-independent phosphorylation of FGFR2 and activation of p38 signaling in mutant skin and calvarial tissues. Treating Fgfr2+/Y394C mice with a p38 kinase inhibitor attenuated skin abnormalities by reversing cell proliferation and differentiation to near normal levels. This study reveals the pleiotropic effects of the FGFR2 Y394C mutation evidenced by cutis gyrata, acanthosis nigricans, and craniosynostosis and provides a useful model for investigating the molecular mechanisms of skin and skull development. The demonstration of a pathogenic role for p38 activation may lead to the development of therapeutic strategies for BSS and related conditions, such as acanthosis nigricans or craniosynostosis.
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Affiliation(s)
- Yingli Wang
- Department of Genetics and Genomic Sciences, Mount Sinai School of Medicine, New York, New York 10029, USA
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46
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Buzási K, Sápi Z, Jermendy G. Acanthosis nigricans as a local cutaneous side effect of repeated human insulin injections. Diabetes Res Clin Pract 2011; 94:e34-6. [PMID: 21839533 DOI: 10.1016/j.diabres.2011.07.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 07/18/2011] [Indexed: 10/17/2022]
Abstract
Acanthosis nigricans is a hyperkeratotic lesion of the epidermis associated with insulin resistance. We present a diabetic patient with acanthosis nigricans at the insulin injection site on the abdominal wall. Neglecting rotation of sites for insulin injections and local hyperinsulinemia may play a role in the development of acanthosis nigricans.
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Affiliation(s)
- Katalin Buzási
- Department of Endocrinology and Angiology, Bajcsy-Zsilinszky Hospital, Maglódi út 89-91, Budapest 1106, Hungary
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Chrysomali E, Piperi E, Sklavounou-Andrikopoulou A. Oral acanthosis nigricans in chronic hepatitis B with a 21-year follow up. J Dermatol 2011; 38:1172-6. [PMID: 21966946 DOI: 10.1111/j.1346-8138.2011.01252.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Acanthosis nigricans is a rare mucocutaneous disorder of unknown etiology that manifests as hyperpigmented velvety plaques, most often on intertriginous areas such as the neck and axillae as well as on mucosal sites such as the oral cavity. The disorder presents either as a paraneoplastic manifestation of an underlying malignancy, especially gastrointestinal adenocarcinomas or in association with obesity, administration of drugs or endocrinopathies, most commonly insulin-resistant diabetes mellitus. In the present article, a case of acanthosis nigricans with oral and cutaneous manifestations in a male patient with chronic hepatitis B infection is described. To the best of our knowledge, this is the first case of benign oral acanthosis nigricans associated with chronic hepatitis B.
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Affiliation(s)
- Evanthia Chrysomali
- Department of Oral Pathology and Medicine, Dental School, National and Kapodistrian University of Athens, Athens, Greece.
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48
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Semple RK, Savage DB, Cochran EK, Gorden P, O'Rahilly S. Genetic syndromes of severe insulin resistance. Endocr Rev 2011; 32:498-514. [PMID: 21536711 DOI: 10.1210/er.2010-0020] [Citation(s) in RCA: 217] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Insulin resistance is among the most prevalent endocrine derangements in the world, and it is closely associated with major diseases of global reach including diabetes mellitus, atherosclerosis, nonalcoholic fatty liver disease, and ovulatory dysfunction. It is most commonly found in those with obesity but may also occur in an unusually severe form in rare patients with monogenic defects. Such patients may loosely be grouped into those with primary disorders of insulin signaling and those with defects in adipose tissue development or function (lipodystrophy). The severe insulin resistance of both subgroups puts patients at risk of accelerated complications and poses severe challenges in clinical management. However, the clinical disorders produced by different genetic defects are often biochemically and clinically distinct and are associated with distinct risks of complications. This means that optimal management of affected patients should take into account the specific natural history of each condition. In clinical practice, they are often underdiagnosed, however, with low rates of identification of the underlying genetic defect, a problem compounded by confusing and overlapping nomenclature and classification. We now review recent developments in understanding of genetic forms of severe insulin resistance and/or lipodystrophy and suggest a revised classification based on growing knowledge of the underlying pathophysiology.
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Affiliation(s)
- Robert K Semple
- Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
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49
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Di Rocco F, Collet C, Legeai-Mallet L, Arnaud E, Le Merrer M, Hadj-Rabia S, Renier D. Crouzon syndrome with acanthosis nigricans: a case-based update. Childs Nerv Syst 2011; 27:349-54. [PMID: 21136065 DOI: 10.1007/s00381-010-1347-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 11/14/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Crouzon syndrome with acanthosis nigricans also named Crouzono-dermo-skeletal is a clinically and genetically distinct entity. It associates a craniofacial phenotype to anomalies of the skin and long bones. This syndrome is due to a specific mutation in FGFR3 gene that can be identified by genetic testing. ILLUSTRATIVE CASES As in our two patients, not all these features might be present and some will be patent only in the infancy or early childhood. Moreover, other organs such as the kidneys might be affected. DISCUSSION Because several organs might be affected the recognition of such syndrome is important for a correct management of the patient as well as a proper information and genetic counseling of the families.
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Affiliation(s)
- Federico Di Rocco
- Unité de Chirurgie Craniofaciale, Neurochirurgie Pédiatrique Hôpital Necker Enfants Malades, Centre de Référence Maladies rares Dysostoses Craniofaciales, 149 rue de Sèvres, 75015 Paris, France.
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Abstract
Achondroplasia is the most common type of short-limbed dwarfism in children resulting from fibroblast growth factor receptor (FGFR) mutations. Activating mutations of FGFR3 also result in other forms of skeletal dysplasia and craniosynostosis. Acanthosis nigricans is associated with these skeletal dysplasias and we recently encountered a skeletal dysplasia along with acanthosis nigricans in a young boy. We report the case due its unusual nature affecting one of twin brothers.
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Affiliation(s)
- K V S Hari Kumar
- Department of Endocrinology, Command Hospital, Lucknow 226002, Uttar Pradesh, India.
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