Diagnosis Of Acanthosis Nigricans Research Articles

Acanthosis Nigricans Is a Strong Predictor of Low Blood Calcidiol Levels in Children and Adolescents.

Background: Clinical consensus differs as to when blood vitamin D (VD) levels should be measured in children. Obesity and metabolic syndrome are risk factors for low VD levels and are also associated with acanthosis nigricans (AN). Objectives: To test whether the clinical diagnosis of AN is a strong predictor for vitamin D deficiency (VDD) in children. Methods: Within the study period (2015-2020), we identified 677 consecutive individuals (age <18 years) with available calcidiol measurements and compared those with (n = 273) and without (n = 404) AN. Bivariate associations and the occurrence of AN were tested using the chi-squared test. Multivariate logistic regression was performed to control for confounding variables, and adjusted odds ratios with 95% confidence intervals (CI) were reported. Multiple regression analysis was performed, and unstandardized beta coefficients, standard errors, and standardized beta coefficients were reported. Results: Individuals with AN had 3.6 times higher odds of VDD than those without (95% CI: 1.38-9.51, P = 0.009). Males had 0.41 times lower odds of having AN than females (95% CI: 0.21-0.79, P = 0.008). Individuals with vitamin D sufficiency (VDS) were much less likely to be diagnosed with metabolic syndrome compared with those who were vitamin D deficient (P = 0.011), even after adjusting for body mass index z-scores. Conclusion: Children and adolescents with AN are at a higher risk of VDD and should likely be tested for low calcidiol levels.

Management of large multiple oral papillary lesions suspected Acanthosis Nigricans: a case report

BackgroundPapillary oral pathologies are a heterogenous group. Both virus-associated and non-virus-associated, malignant and benign entities may enter the differential diagnosis. In some cases, oral papillary lesions are part of a variety of skin or systemic disorders and syndromes. It is a challenge for clinicians to identify and treat the various etiology of oral papillary lesions.Case presentationThis case report describes the successful management of large multiple oral papillary lesions in a 65-year-old female. Combined the clinical features, pathological findings and medical history, the patient was tended to be the diagnosis of Acanthosis Nigricans and was successfully managed. The neuro-endocrine-immune network and mechanical factors in the pathogenesis of oral papillary lesions of Acanthosis Nigricans were discussed. Common questions regarding differential diagnosis, the management of oral papillary lesions of Acanthosis Nigricans patients and follow-up visits are addressed.ConclusionsThe neuro-endocrine-immune network and mechanical factors play important roles in the pathogenesis of oral papillary lesions with Acanthosis Nigricans. Removing traumatic factors of oral mucosa and the treatment of underlying systemic diseases is necessary for Acanthosis Nigricans patients with oral papillary lesions. The clinical management plan should comprise both the local treatments of oral papillary lesions and the systemic treatment of underlying diseases. Multidisciplinary correlation is helpful and the patient’s collaboration is necessary to arrive at the correct diagnosis and successful long-term treatment effect. From the clinician’s perspective, recognizing various causes and clinical presentations of oral papillary lesions will help guide management.

Prevalence of Acanthosis nigricans and Related Factors in Iranian Obese Children.

Recognition of Acanthosis nigricans (AN) provides important opportunities for screening of obesity syndrome, dyslipidemia, hypertension and insulin resistance with diabetes mellitus 2. Considering the high prevalence of obesity among Iranian children, we designed this study to estimate the prevalence of AN and related laboratory factors in Iranian obese children. Seventy-one obese children were enrolled in this study. Diagnosis of AN was done by clinical examination. Body mass index (BMI), fasting blood sugar, total cholesterol, triglycerides (TG), alanine aminotransferase, aspartate aminotransferase (AST), alkaline phosphatase, high- and low-density lipoprotein cholesterol, insulin, thyroid-stimulating hormone, free thyroxin (fT4), calcium, phosphorus and 25-hydroxyvitamin D were measured with routine techniques. Collected data were compared between cases with AN and without AN. Independent t-test was used for comparison of variables. Twenty-five of children were female (35.2%). Forty-eight children (67.6%) had AN. In 20 cases (28.2%), homeostasis model assessment-insulin resistance (HOMA-IR) was <2.5 and in 51 (71.8%), HOMA-IR was more than 2.5. Mean BMI, insulin, HOMA-IR, TG and AST levels were significantly higher in cases with AN. Obese children with AN are at risk of developing diabetes. Hence early identification of this feature and precise evaluation of children is recommended.

Insulin sensitizing agent (metformin) improves clinical pregnancy rate in clomiphene citrate resistant polycystic ovarian syndrome patients with acanthosis nigricans

ObjectiveThere are several studies that showed a positive correlation between acanthosis nigricans (AN) with hyperinsulinemia and increased insulin resistance. The present study evaluated the effect of adding insulin sensitizing agent (metformin) to clomiphene citrate (CC) on improving insulin resistance parameters and pregnancy rate (PR) in clomiphene-resistant polycystic ovary (PCOS) patients with AN.DesignA double blinded randomized control trialed.Materials and MethodsSixty six CC resistant PCO patients (unsatisfactory ovulation after at least 3 month of CC induction) with AN had been recruited in the study. All study participants had proper clinical evaluation to ensure the diagnosis of AN. Additionally, day 3 follicle stimulating hormone level, fasting insulin, fasting glucose and homeostatic model assessment used to quantify insulin resistance (HOMA–IR) were done. Randomization was done using serial number closed opaque envelopes. Blinding was done using two identical packages for induction (group I) two 50 mg CC tablets taken from day 3 to day 7 of the cycle + placebo tablets taken twice daily all through the cycle (Group II) received the above CC dose + metformin 500 mg twice daily continuously for three cycles. Insulin resistance parameters as well as clinical pregnancy rate had been evaluated in both groups. The statistical analysis was done using Chi-square and Fischer exact tests.ResultsTable 1GI(CC)GII (CC + metformin)P. valueMeanSDMeanSDFasting glucose96.856.8489.766.220.001Fasting insulin12.063.127.832.950.005HOMA_IR2.900.711.720.670.001 Open table in a new tab ConclusionAddition of metformin to CC in PCOS patients with AN, decreases insulin resistance and improve clinical pregnancy rate in patients with previous unsatisfactory response to CC alone. ObjectiveThere are several studies that showed a positive correlation between acanthosis nigricans (AN) with hyperinsulinemia and increased insulin resistance. The present study evaluated the effect of adding insulin sensitizing agent (metformin) to clomiphene citrate (CC) on improving insulin resistance parameters and pregnancy rate (PR) in clomiphene-resistant polycystic ovary (PCOS) patients with AN. There are several studies that showed a positive correlation between acanthosis nigricans (AN) with hyperinsulinemia and increased insulin resistance. The present study evaluated the effect of adding insulin sensitizing agent (metformin) to clomiphene citrate (CC) on improving insulin resistance parameters and pregnancy rate (PR) in clomiphene-resistant polycystic ovary (PCOS) patients with AN. DesignA double blinded randomized control trialed. A double blinded randomized control trialed. Materials and MethodsSixty six CC resistant PCO patients (unsatisfactory ovulation after at least 3 month of CC induction) with AN had been recruited in the study. All study participants had proper clinical evaluation to ensure the diagnosis of AN. Additionally, day 3 follicle stimulating hormone level, fasting insulin, fasting glucose and homeostatic model assessment used to quantify insulin resistance (HOMA–IR) were done. Randomization was done using serial number closed opaque envelopes. Blinding was done using two identical packages for induction (group I) two 50 mg CC tablets taken from day 3 to day 7 of the cycle + placebo tablets taken twice daily all through the cycle (Group II) received the above CC dose + metformin 500 mg twice daily continuously for three cycles. Insulin resistance parameters as well as clinical pregnancy rate had been evaluated in both groups. The statistical analysis was done using Chi-square and Fischer exact tests. Sixty six CC resistant PCO patients (unsatisfactory ovulation after at least 3 month of CC induction) with AN had been recruited in the study. All study participants had proper clinical evaluation to ensure the diagnosis of AN. Additionally, day 3 follicle stimulating hormone level, fasting insulin, fasting glucose and homeostatic model assessment used to quantify insulin resistance (HOMA–IR) were done. Randomization was done using serial number closed opaque envelopes. Blinding was done using two identical packages for induction (group I) two 50 mg CC tablets taken from day 3 to day 7 of the cycle + placebo tablets taken twice daily all through the cycle (Group II) received the above CC dose + metformin 500 mg twice daily continuously for three cycles. Insulin resistance parameters as well as clinical pregnancy rate had been evaluated in both groups. The statistical analysis was done using Chi-square and Fischer exact tests. ResultsTable 1GI(CC)GII (CC + metformin)P. valueMeanSDMeanSDFasting glucose96.856.8489.766.220.001Fasting insulin12.063.127.832.950.005HOMA_IR2.900.711.720.670.001 Open table in a new tab ConclusionAddition of metformin to CC in PCOS patients with AN, decreases insulin resistance and improve clinical pregnancy rate in patients with previous unsatisfactory response to CC alone. Addition of metformin to CC in PCOS patients with AN, decreases insulin resistance and improve clinical pregnancy rate in patients with previous unsatisfactory response to CC alone.

Acral acanthosis nigricans (acral acanthotic anomaly).

A 28-year-old female, apparently healthy and thinly built, presented with mildly itchy hyperpigmented hyperkeratotic plaques on her feet since three years. There were no systemic features suggestive of diabetes or other endocrinopathies associated with acanthosis nigricans (AN). She was not on any medication prior to onset of lesions. On examination, multiple well-defined hyperpigmented, hyperkeratotic plaques were present on the dorsum of several toes in a bilateral symmetrical manner [Figure 1]. Other skin sites, the scalp, palms, soles and mucosae were spared. Routine blood investigations, fasting and postprandial blood sugar and routine urine analysis were within normal limits. The liver enzymes, thyroid hormones and growth hormone were within normal range. Serum leptin and insulin level estimation could not be done as these were not available in our institute. Radiographic examination of the chest, skull and hands did not reveal any abnormality. Abdominal and pelvic ultrasonography was non-contributory. Biopsy of the skin showed hyperkeratosis, papillomatosis, increased pigmentation of the basal cell layer and mild acanthosis, with a sparse inflammatory infiltrate of mononuclear cells in the upper dermis [Figure ​[Figure2a2a and ​andb].b]. These histopathological findings were consistent with the diagnosis of AN. A final diagnosis of acral AN was made, considering clinical and histopathological findings. Figure 1 Hyperpigmented hyperkeratotic plaques on dorsal surface of toes Figure 2 (a) Hyperkeratosis, acanthosis, papillomatosis and sparse mononuclear cell infiltration in dermis (H and E, ×40) (b) Higher magnification (H and E, ×100) AN is a common presentation in the out-patient department and usually affects the neck, axillae, groin, inner aspects of the thighs, flexor and extensor surface of the elbows and knees, dorsal joints of the hands, umbilicus and anus. Schwartz has categorized the entity into the following eight types: benign, malignant, associated with obesity, syndromic, unilateral, drug induced, mixed and acral.[1] In acral AN, also called as acral acanthotic anomaly, the lesions are localized to the knee, ankle, phalangeal joints and tarsophalangeal joints.[1] It is apparently more common in persons with a dark complexion and affects acral areas without prominent affection of axilla and other flexures.[2] The clinical significance of acral AN is ambiguous and more studies are needed to settle this issue. According to Schwartz, this type of AN essentially occurs in healthy black people and does not, on its own, call for a vigilant work-up of those afflicted; for the possible presence of an internal malignancy. However, recently it has been reported in association with dermatofibrosarcoma protuberans, non-Hodgkin's lymphoma[3] and gastric adenocarcinoma.[4] Diagnosis is mostly clinical and can be confirmed by histopathology. In the majority of cases, improvement of the skin lesions is the primary concern of patients presenting to dermatologists. Treatment of its underlying condition often results in improvement of AN. The type occurring with obesity usually improves with weight loss. Etretinate, metformin, tretinoin, calcipotriol, urea, salicyclic acid, CO2 laser ablation and long pulsed alexandrite laser therapy have been reported as successful treatments in individual cases.[1,2]

Correlation between acanthosis nigricans and insulin resistance in obese children in Manado

Methods We performed a cross sectional analytic observational study. One hundred twenty three obese children, ages 10 – 14 years with and without acanthosis nigricans got examined for insulin resistance using Homeostasis Model Assessment of Insulin Resistance Index (HOMA-IR). Diagnosis of acanthosis nigricans is confirmed by a dermatologist. This study took place in Wenang district, Manado, North Sulawesi from October 2009 until January 2010.

Generalized benign acanthosis nigricans

with normal growth and developmental milestones, presented with asymptomatic generalized hyperpigmentation. It started spontaneously at the age of 2 years, around the neck and axilla, and spread insidiously to involve the other parts of body. The skin gradually became thickened and rugose. There was no history of drug intake, polyuria, polydypsia, loss of appetite, excess weight gain or loss. Cutaneous examination revealed generalized hyperpigmentation with thickening of skin, which was accentuated in the back and sides of the neck, axillae, groins, dorsal hands and flexural areas of knees and elbows. The characteristic velvety plaque with corrugated surface could be appreciated in the flexures (Fig.1). Mucous membranes, palms, soles, hair, and nails were unremarkable. Routine investigations, thyroid profile, insulin level, lipid profile, complete liver and renal function tests, and oral glucose tolerance test were within normal limits. Histopathological examination revealed marked hyperkeratosis, acanthosis and papillomatosis and was consistent with diagnosis of acanthosis nigricans. Epidermolytic hyperkeratosis was excluded on the basis of absence of bullous lesions and histopathological findings. Absence of mucosal and systemic involvement, and velvety texture of lesions in our patient were against the diagnoses of hemochromatosis and Addison’s disease.

A case of squamous cell carcinoma of lung presenting with paraneoplastic type of acanthosis nigricans

A 70-years-old male presented with blackening of both hands and face for last six months which was progressive and attended dermatology outpatients department. Dermatologist opined the skin lesions as acanthosis nigricans. He was referred to our department to evaluate for any underlying internal malignancy as he was a smoker. His chest X-ray revealed right sided hilar prominence with a mid zone cavity with fluid level. Fibreoptic bronchoscopy was done, there was one ulcerative growth in right middle lobe bronchus. Biopsy from the ulcer revealed probable squamous cell carcinoma. CT scan of thorax was also done and CT guided FNAC of Rt lung lesion yielded non small cell carcinoma. His skin lesions were also biopsied and diagnosis of acanthosis nigricans was confirmed. Here we report a case of acanthosis nigricans associated with non-small cell cancer of lung.

Eyelid Involvement in Acanthosis Nigricans: The Importance of Systemic Screening

A 53-year-old man presented with thickening and hyperpigmentation of the eyelids. After the diagnosis of acanthosis nigricans was made, further investigation of a possible underlying disorder, including biochemical and instrumental examinations, indicated the presence of glucose intolerance, which had been diagnosed 3 years after the clinical appearance of acanthosis nigricans. Eyelid involvement in acanthosis nigricans is rare. Ophthalmologists should be aware of the possibility that acanthosis nigricans can exist in the periocular area and perform a systemic assessment of the patient for the presence of an underlying condition.

Acanthosis Nigricans with Endometrial Carcinoma: Case Report and Review of the Literature

Background. Acanthosis nigricans is classified into benign and malignant forms on the basis of clinical associations. The main interest in acanthosis nigricans has been based on its association with malignancy because of the dramatic clinical appearance of the skin lesions and the usually rapidly fatal nature of the underlying disease. “Tripe palms” is a descriptive term of acanthosis nigricans of the palms. It more often is associated with internal malignancy. Most importantly, it often precedes the diagnosis of a new or recurrent tumor. Malignant acanthosis nigricans is most commonly associated with intra-abdominal malignancies. There are very few reports in the literature of malignant acanthosis nigricans associated with gynecological malignancies. Only five cases of endometrial carcinoma associated with acanthosis nigricans and/or tripe palms have been reported in the literature.Case. A 69-year-old African-American female presented with skin changes consistent with the diagnosis of acanthosis nigricans and tripe palms. More than 14 months later she was found to have endometrial carcinoma. She subsequently underwent total abdominal hysterectomy and salpingo-oophorectomy followed by chemotherapy with paclitaxel and carboplatin. During treatment of the underlying malignancy the skin condition dramatically improved.Conclusion. Tripe palms can be associated with endometrial carcinoma and may be the first sign of malignancy. Malignant acanthosis nigricans may improve with treatment of the underlying malignancy. Patients who present with tripe palms may need to undergo workup to search for underlying malignancy.

Ophthalmic Manifestations of Acanthosis Nigricans

A 77-year-old man had fleshy papillomatous lesions on his eyelid margins, which initially were accompanied by lesions on his lips and tongue and plaques on his scrotum, areolae, neck, axillae, and hands. He had had adenocarcinoma of the sigmoid colon and stomach. Based on the clinical findings and histopathologic evaluation of the eyelids (showing papillomatous changes with hyperkeratosis and mild acanthosis), the diagnosis of acanthosis nigricans was made. Acanthosis nigricans may be benign or malignant; in this patient it was malignant. The malignant form is usually of gastrointestinal origin, and in adults may be a marker for an occult malignancy.

Malignant Acanthosis Nigricans: A Case Report

The authors present a case of malignant acanthosis nigricans that has two unusual aspects. The first is involvement of the lid margins with confluent papillomata, causing severe visual impairment, and the second is the association with lung malignancy. A 65-year-old Portuguese man presented with decreased vision, papillomatous lid lesions, pruritus, and progressive thickening of the skin of his face, neck, axillae, and inguinal creases. A diagnosis of acanthosis nigricans was made after skin biopsy. Systemic investigations showed a suprahilar mass, and biopsy was positive for squamous cell carcinoma of the lung. The patient underwent excision of papillomata from all four lid margins, and this was repeated 1 year later. He also completed a course of palliative radiotherapy. Malignant acanthosis nigricans is rarely associated with lung neoplasms, being more commonly a manifestation of intra-abdominal malignancies. Of note in this case is the extensive ocular involvement and visual impairment.

PIGMENTATION OF THE SKIN (ADDISON'S DISEASE) ASSOCIATED WITH LYMPHOSARCOMA INVOLVING PARTICULARLY THE RETROPERITONEAL LYMPH NODES OF THE SOLAR PLEXUS REGION

The patient, of whose history the final chapter is given in this paper, presented a condition of extraordinary interest to the many physicians who saw him during the six and a half years of its course, and who made a great variety of diagnoses. He was shown to the Chicago Dermatological Society by Drs. Ormsby and Mitchell, November, 1919, as having a case of hyperpigmentation, and histologic sections of the skin were demonstrated by Dr. R. M. Strong. The discussion 1 centered about the diagnosis of acanthosis nigricans. It was supposed at this time that the patient had a duodenal ulcer because of attacks of indigestion and abdominal pain extending over a period of three years, and the possibility of an early acanthosis nigricans (pigmentation without thickening) associated with abdominal malignancy was suggested. In the discussion, Dr. U. J. Wile of Ann Arbor said he thought that, while no positive