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Verma S, Sandhu S, Kotwal N, Madke B, Yadav N, Vasudevan B. Review of facial acanthosis nigricans: Easy to diagnose and difficult to treat marker of hyperinsulinemia/metabolic syndrome. Med J Armed Forces India 2024; 80:257-269. [PMID: 38799993 PMCID: PMC11117019 DOI: 10.1016/j.mjafi.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
Facial acanthosis nigricans (FAN) is an increasingly discussed anatomical variation of acanthosis nigricans (AN). Its presentation as brown to black pigmentation with ill-defined blurred margins with varying degree of textural changes commonly over forehead, temporal, and malar regions of the face predominantly in dark-skinned individuals with a male predilection can be confused with other common facial melanoses. Its pathogenesis, clinical features, and management are in many ways similar to in the commonly described areas like neck and major flexural areas. Understanding of FAN has gained momentum in the past decade with studies highlighting its association with various metabolic abnormalities particularly insulin resistance and obesity. It is now being considered to be a cutaneous marker of metabolic syndrome. While there is uniformity in its clinical description, there appears to be scope for further in depth biochemical and histopathological studies to link the pigmentation, altered texture and microscopic changes in individuals presenting with FAN and hyperinsulinemia with or without other features of metabolic syndrome. It awaits a consensus on grading its severity and correlating it with histological features as patients often hesitate to be subjected to a biopsy of the face. This is a review of current literature pertaining to FAN. Newer clinical, dermoscopic, histopathological, and biochemical insights will help to understand this relatively new entity.
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Affiliation(s)
- Shyam Verma
- Consultant (Dermatology), Nirvan Skin Clinic, Vadodara, Gujarat, India
| | - Sunmeet Sandhu
- Senior Medical Officer, Air Force Station, Amritsar Cantt, India
| | - Narendra Kotwal
- Director & Commandant, Armed Forces Medical College, Pune, India
| | - Bhushan Madke
- Professor & Head (Dermatology, Venerology & Leprosy), Jawaharlal Nehru Medical College, Datta Meghe Inst of Higher Education & Research, Sawangi Meghe, Wardha, Maharashtra, India
| | - Nidhi Yadav
- Constultant Dermatologist, ShriRam Yadav Skin Clinic, Namaul, Haryana, India
| | - Biju Vasudevan
- Professor & Head, Department of Dermatology, Armed Forces Medical College, Pune, India
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Xia J, Melian C, Guo W, Usmani H, Clark R, Lozeau D. Vitiligo and Metabolic Syndrome: Systematic Review and Meta-Analysis. JMIR DERMATOLOGY 2022; 5:e34772. [PMID: 37632859 PMCID: PMC10334901 DOI: 10.2196/34772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/20/2022] [Accepted: 01/23/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) has been associated with various skin conditions including vitiligo. However, the association between these 2 conditions has yet to be determined by quantitative meta-analysis. OBJECTIVE The aim of this paper was to determine the association between vitiligo and metabolic syndrome via systematic review and meta-analysis. METHODS A systematic literature search of Pubmed, Embase, Cochrane, and Web of Science was performed for all published literature prior to August 16, 2020. Case control and prospective cross-sectional studies analyzing the association between vitiligo and MetS were included in this review. The primary outcome measures include the type of vitiligo, diagnostic criteria for MetS, components of MetS (waist circumference, blood pressure, triglycerides, fasting glycemic index, and high-density lipoprotein cholesterol), low-density lipoprotein cholesterol levels, and BMI. A meta-analysis was performed to evaluate the prevalence and association of MetS in patients with vitiligo. RESULTS A total of 6 studies (n=734 participants) meeting eligibility criteria were included for systematic review and meta-analysis. The pooled prevalence of MetS in patients with vitiligo was (0.296, 95% CI 0.206, 0.386; P<.001). Patients with vitiligo were no more likely to develop MetS compared to control patients (odds ratio 1.66, 95% CI 0.83, 3.33; P=.01). A leave-one-out sensitivity analysis showed a significant association between MetS and vitiligo (P<.001). Significant elevations in fasting glycemic index (mean difference 5.35, 95% CI 2.77, 7.93; P<.001) and diastolic blood pressure (mean difference 1.97, 95% CI 0.02, 3.92; P=.05) were observed in patients with vitiligo compared to control patients. CONCLUSIONS The association between vitiligo and metabolic syndrome carries important clinical implications. Dermatologists and other multidisciplinary team members should remain vigilant when treating this patient population in order to prevent serious cardiovascular complications that may arise as a result of metabolic disease.
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Affiliation(s)
- Joyce Xia
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Christina Melian
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - William Guo
- Department of Dermatology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Hunya Usmani
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Richard Clark
- Department of Dermatology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
- Department of Biomedical Engineering, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Daniel Lozeau
- Department of Dermatology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
- Department of Pathology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
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Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Acanthosis Nigricans: An Updated Review. Curr Pediatr Rev 2022; 19:68-82. [PMID: 36698243 DOI: 10.2174/1573396318666220429085231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Early recognition of acanthosis nigricans is important because acanthosis nigricans can be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. OBJECTIVE The purpose of this article is to familiarize pediatricians with the clinical manifestations, evaluation, diagnosis, and management of acanthosis nigricans. METHODS A search was conducted in November 2021in PubMed Clinical Queries using the key term "acanthosis nigricans". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS Acanthosis nigricans is characterized by symmetric, hyperpigmented, and velvety plaques with ill-defined borders, typically involving intertriginous areas. Obesity is the most common cause of acanthosis nigricans which is increasingly observed in obese children and adolescents and can serve as a cutaneous marker of insulin resistance. Early recognition of acanthosis nigricans is important because acanthosis nigricans can also be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. This may consist of weight reduction, discontinuation of causative drugs, treatment of underlying endocrinopathy, or treatment of an underlying malignancy. For patients with isolated acanthosis nigricans and for those whose underlying cause is not amenable to treatment, treatment of the lesion may be considered for cosmetic reasons. Topical retinoids, vitamin D analogs, chemical peels, and other keratolytics are often used for the treatment of localized lesions. Seldom, systemic therapy such as oral retinoids may be considered for extensive or generalized acanthosis nigricans and acanthosis nigricans unresponsive to topical therapy. Other uncommon treatment modalities include dermabrasion, laser therapy, and surgical removal. CONCLUSION Although acanthosis nigricans is treatable, a complete cure is difficult to achieve. The underlying cause should be treated, if possible, to resolve and prevent the recurrence of acanthosis nigricans. The diagnosis is mainly clinical, based on the characteristic appearance (symmetrically distributed, hyperpigmented, velvety, papillomatous, hyperkeratotic plaques with ill-defined borders) and the typical sites (intertriginous areas, flexural area, and skin folds) of the lesions. The diagnosis might be difficult for lesions that have atypical morphology or are in an unusual location. Clinicians should be familiar with the clinical signs, evaluation, diagnosis, and therapy of acanthosis nigricans because of the link between it and underlying diseases.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
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Fatima F, Das A, Kumar P, Datta D. Skin and Metabolic Syndrome: An Evidence Based Comprehensive Review. Indian J Dermatol 2021; 66:302-307. [PMID: 34446955 PMCID: PMC8375528 DOI: 10.4103/ijd.ijd_728_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Metabolic syndrome is currently considered to be a global epidemic, causing a significant increase in the cost of health care, apart from deteriorating the quality of life. Skin serves as a mirror of underlying metabolic sinister. Various dermatological conditions like psoriasis, acanthosis nigricans, lichen planus, acne vulgaris, acrochordons, atopic dermatitis, etc. have been reported to be associated with metabolic syndrome. We hereby present an evidence-based review of the various dermatological conditions and their association with the development of metabolic syndrome.
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Affiliation(s)
- Farhat Fatima
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Piyush Kumar
- Department of Dermatology, Katihar Medical College and Hospital, Katihar, Bihar, India
| | - Debatri Datta
- Consultant Dermatologist, Oliva Skin and Hair Clinic, Kolkata, West Bengal, India
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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: 34] [Impact Index Per Article: 11.3] [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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Thappa DM, Chandrashekar L, Rajappa M, Usha R, Muthupandi K, Mohanraj PS, Munisamy M, Singh N. Assessment of Patients with Periorbital Melanosis for Hyperinsulinemia and Insulin Resistance. Indian Dermatol Online J 2021; 12:244-249. [PMID: 33959520 PMCID: PMC8088194 DOI: 10.4103/idoj.idoj_491_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/02/2020] [Accepted: 10/21/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Periorbital melanosis (PM) is one of the most common dermatological condition seen in routine practice. Several cutaneous markers such as acanthosis nigricans have been associated with insulin resistance (IR). However, the association of PM with IR needs to be substantiated. Objective: The objective of the study is to evaluate the association of circulating adipokines and IR with PM. Materials and Methods: In this cross-sectional study, we recruited 100 patients with PM and 100 age- and gender-matched healthy controls. The serum levels of leptin, adiponectin, fasting glucose, fasting insulin, insulin-like growth factor-1 (IGF-1), homeostatic model assessment of insulin resistance (HOMA-IR), and leptin: adiponectin ratio (L/A ratio) were assayed. Results: The serum levels of leptin, fasting glucose, fasting insulin, HOMA-IR, L/A ratio were significantly higher in patients with PM as compared to controls. The serum levels of adiponectin were significantly lower in cases as compared to controls. On multivariate regression analysis, leptin, adiponectin, and HOMA-IR were found to be significant, even after adjusting for BMI, blood pressure and LDL and HDL cholesterol. Conclusion: Our findings suggest that patients with PM have hyperinsulinemia, IR, and elevated L/A ratio. PM as a marker of IR in adults may help in identifying patients early and thus aid in the early prevention and management of the disease.
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Affiliation(s)
- Devinder M Thappa
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Laxmisha Chandrashekar
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Medha Rajappa
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - R Usha
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - K Muthupandi
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Palani S Mohanraj
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Malathi Munisamy
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Nidhi Singh
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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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: 13] [Impact Index Per Article: 2.6] [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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Hu Y, Zhu Y, Lian N, Chen M, Bartke A, Yuan R. Metabolic Syndrome and Skin Diseases. Front Endocrinol (Lausanne) 2019; 10:788. [PMID: 31824416 PMCID: PMC6880611 DOI: 10.3389/fendo.2019.00788] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/29/2019] [Indexed: 12/13/2022] Open
Abstract
The increasing prevalence of Metabolic syndrome (MetS) is a worldwide health problem, and the association between MetS and skin diseases has recently attracted growing attention. In this review, we summarize the associations between MetS and skin diseases, such as psoriasis, acne vulgaris, hidradenitis suppurativa, androgenetic alopecia, acanthosis nigricans, and atopic dermatitis. To discuss the potential common mechanisms underlying MetS and skin diseases, we focus on insulin signaling and insulin resistance, as well as chronic inflammation including adipokines and proinflammatory cytokines related to molecular mechanisms. A better understanding of the relationship between MetS and skin diseases contributes to early diagnosis and prevention, as well as providing clues for developing novel therapeutic strategies.
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Affiliation(s)
- Yu Hu
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Yun Zhu
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Ni Lian
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Min Chen
- Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and Sexually Transmitted Infections, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
- *Correspondence: Min Chen
| | - Andrzej Bartke
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
| | - Rong Yuan
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, United States
- Rong Yuan
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