Prevalence Of Skin Lesions Research Articles

Survey of flea infestation in dogs and cats in the United Kingdom during 2005

During 2005, 31 uk veterinary practices participated in a survey of flea infestation, during which 2653 dogs and 1508 cats were examined for evidence of flea infestation and skin disease...

Detecting arsenic-related skin lesions: Experiences from a large community-based survey in Bangladesh

A cross-sectional survey was conducted in Matlab, Bangladesh, to determine the prevalence of skin lesions (a three-step procedure) associated with arsenic exposure and discuss validity and feasibility in relation to recommended screening algorithms. Cases with skin lesions were identified by screening above 4 years of age (n = 166,934). Trained field teams conducted a careful house-to-house screening and identified 1682 individuals with skin lesions, who were referred to physicians for confirmation. Physicians diagnosed 579 cases as probable and documented all these with digital photographs. Two experts inspected all photographs for consensus agreement that was reached for 504 cases. Using the experts' opinions as reference, the positive predictive value of the physicians' diagnosis was 87% (male = 82% vs. female = 94%; p < 0.01). The physicians had difficulties in separating arsenic-induced keratosis from differential diagnoses, while probability for correct diagnosis was high for arsenic-related pigmentation changes. Including information on current arsenic concentration in drinking water (which was masked at time of skin examination) or urine in the diagnostic algorithm should have increased the number of false negative cases. In the present transition of drinking water sources these markers of current exposure levels provide no information on past exposure. A 2 – 3 step procedure with house-to-house screening and clinic-based confirmation of arsenic-induced skin lesions is a feasible approach. Information on arsenic concentration in current water sources or in urine should not have improved the precision in the diagnosis. These results may have policy implications for community screening of arsenic-related skin lesions in Bangladesh and elsewhere.

Glutathione S-transferases M1 and T1 polymorphisms and arsenic content in hair and urine in two ethnic clans exposed to indoor combustion of high arsenic coal in Southwest Guizhou, China

A total of 2,402 cases of arsenic-related skin lesions (as of 2002) in a few villages of China's Southwest Guizhou Autonomous Prefecture represent a unique case of endemic arseniasis related with indoor combustion of high arsenic coal. A significant difference of skin lesion prevalence was observed between two clans of different ethnicities (Hmong and Han) in one of the hyperendemic villages in this prefecture. This study was focused on a possible involvement of GST T1 and M1 polymorphisms in risk modulation of skin lesions and in the body burden of As in this unique case of As exposure. GST T1 and M1 polymorphisms were genotyped by an allele-specific PCR-based procedure. Total As contents in hair and urine samples as well as environmental samples of the homes of the two ethnic clans were analyzed. No significant deviations in the population frequencies of GST T1 and M1 0/0 genotypes or their combination were recorded between diagnosed skin lesion patients and asymptomatic individuals in both clans. Significantly higher As contents in hair and urine were observed in GSTM1 0/0 carriers, not in GSTT1 0/0 carriers. After stratified by ethnicity and gender, a statistically significant association of the GSTM1 0/0 genotype and higher As content in hair was only confirmed in the subgroups of ethnic Han clan members and all male villagers, not in ethnic Hmong clan members or in females. GST T1 and M1 homozygous deletions were not associated with an increased susceptibility to skin lesions in long-term exposure to indoor combustion of high As coal. The polymorphic status at the locus of GSTM1 might modulate individual's body burden of total As in some Chinese ethnic groups.

Yaws disease in a wild gorilla population and its impact on the reproductive status of males

We evaluated the prevalence of skin lesions in a gorilla population in the Republic of Congo. The observed lesions were typical of yaws, a treponematosis described in gorillas and humans living in tropical regions. Among the 377 gorillas identified, 17% presented skin lesions, mainly on their faces. The worst cases presented physical handicaps because of the deep lesions. As in humans, lesions break out when individuals are young. Lesions were more prevalent among males than females above 8 years old. This sex-bias prevalence could result from the behavioral characteristics of males through a greater exposure to wounds. Lesions were also more prevalent in unmated adult males (either solitaries or those living in nonbreeding groups) than in males leading breeding groups. In the case of the latter, nonaffected and affected leading males had a similar number of infants and juveniles. Still, none of the leading males ever presented serious handicaps because of the skin lesions. This suggests that adult females could favor males without lesions. Finally, lesions were more prevalent among immature animals in nonbreeding groups than in breeding groups, suggesting that either young animals with lesions disperse earlier from their natal groups, or that the disease spreads faster in nonbreeding groups. Our results provide some insights into the spread of a disease in a wild population. Further studies are required to determine if the vigor of males affects the development of the disease and if affected individuals experience social discrimination inducing a negative impact on population dynamics.

Wells Syndrome in Adults and Children

Wells syndrome, an uncommon inflammatory dermatosis, is characterized by protean cutaneous manifestations, suggestive but not specific histopathologic findings, and usually a recurrent course. Because of its original description as a distinct entity, it has come to be regarded as an abnormal eosinophilic response to a number of causative agents. The medical records of 19 patients (12 adults and 7 children) with Wells syndrome referred to the Institute of Dermatological Sciences from 1990 to 2005 were evaluated for the type and prevalence of skin lesions, clinical course and response to treatment, and possibly associated systemic symptoms, as well as histologic, laboratory, and immunofluorescence findings. The classic plaque-type variant proved to be the most common presentation in children but not in adults, who more frequently had the annular granuloma-like variant. Unilesional forms were found to occur more frequently in children. The course was recurrent, although slowly progressing, with a mean duration of disease of 5 years for adults and 3 years for children. We emphasize the concept that the diagnosis of Wells syndrome is a clinicopathologic diagnosis. Although it should be classified within a spectrum that includes multisystem eosinophilic disorders, such as Churg-Strauss and hypereosinophilic syndromes, Wells syndrome, which has 7 variants, is a distinct cutaneous disease lacking systemic involvement.

Health Effects of Arsenic Longitudinal Study (HEALS): Description of a multidisciplinary epidemiologic investigation

Health Effects of Arsenic Longitudinal Study (HEALS), a multidisciplinary and large prospective cohort study in Araihazar, Bangladesh, was established to evaluate the effects of full-dose range arsenic (As) exposure on various health outcomes, including premalignant and malignant skin tumors, total mortality, pregnancy outcomes, and children's cognitive development. In this paper, we provide descriptions of the study methods including study design, study population, data collection, response rates, and exposure and outcome assessments. We also present characteristics of the study participants including the distribution of exposure and the prevalence of skin lesion at baseline recruitment. A total of 11,746 married men and women between 18 and 75 years of age participated in the study at baseline (a response rate of 98%) and completed a full questionnaire interview that included a food frequency questionnaire, with a response rate of 98%. Among the 98% of the participants who completed the clinical evaluation, over 90% provided blood samples and spot urine samples. Higher educational status, male gender, and presence of premalignant skin lesions were associated with an increased likelihood of providing blood and urine samples. Older participants were less likely to donate a blood sample. About one-third of the participants consumed water from a well with As concentration in each of three groups: >100 microg/l, 25-100 microg/l, and <25 microg/l. Average urinary As concentrations were 140 and 136 microg/l for males and females, respectively. HEALS has several unique features, including a prospective study design, comprehensive assessments of both past and future changes in As exposure at the individual level, a large repository of biological samples, and a full dose range of As exposures in the study population. HEALS is a valuable resource for examining novel research questions on the health effects of As exposure.

Dermatoses em pacientes com diabetes mellitus

It is yet unknown the relationship between diabetes and determinants or triggering factors of skin lesions in diabetic patients. The purpose of the present study was to investigate the presence of unreported skin lesions in diabetic patients and their relationship with metabolic control of diabetes. A total of 403 diabetic patients, 31% type 1 and 69% type 2, underwent dermatological examination in an outpatient clinic of a university hospital. The endocrine-metabolic evaluation was carried out by an endocrinologist followed by the dermatological evaluation by a dermatologist. The metabolic control of 136 patients was evaluated using glycated hemoglobin. High number of dermophytosis (82.6%) followed by different types of skin lesions such as acne and actinic degeneration (66.7%), pyoderma (5%), cutaneous tumors (3%) and necrobiosis lipoidic (1%) were found. Among the most common skin lesions in diabetic patients, confirmed by histopathology, there were seen necrobiosis lipoidic (2 cases, 0.4%), diabetic dermopathy (5 cases, 1.2%) and foot ulcerations (3 cases, 0.7%). Glycated hemoglobin was 7.2% in both type 1 and 2 patients with adequate metabolic control and 11.9% and 12.7% in type 1 and 2 diabetic patients, respectively, with inadequate metabolic controls. A higher prevalence of dermatophytoses was seen in the both groups with inadequate metabolic control. The results showed a high prevalence of skin lesions in diabetic patients, especially dermatophytoses. Thus, poor metabolic control of diabetes increases patient's susceptibility to skin infections.

P53 Expression in circulating lymphocytes of non-melanoma skin cancer patients from an arsenic contaminated region in Mexico. A pilot study

Arsenic is a common environmental toxicant and epidemiological studies associate arsenic exposure with various pathologic disorders and several types of cancer. Skin cancers are the most common arsenic-induced neoplasias and the prevalence of skin lesions has been reported to be significantly elevated in individuals exposed to arsenic via drinking water in Mexico. Being lymphocytes the main cells used for human monitoring, we evaluated the expression of p53 protein in the lymphocytes from 44 healthy individuals and 19 samples from individuals living in a chronic arsenicism endemic region. Of the latter group, 12 individuals had non-melanoma skin cancer and 9 of them expressed p53 in the circulating lymphocytes, whereas only one of the 7 non-cancer arsenic exposed individuals expressed it. In the healthy non-arsenic exposed group only one from 44 individuals expressed the protein. These results suggest a clear relationship between non-melanoma skin cancer and p53 expression in circulating lymphocytes. p53 expression in circulating lymphocytes should be evaluated as a potential biomarker of effect or susceptibility.

Sensitivity and specificity of screening cutaneous pre-malignant and malignant lesions

The incidence of melanoma is increasing worldwide, prevalence of malignant epithelial tumors is high and early diagnosis reduces significantly the morbi-mortality of these diseases. The purpose of the study is to estimate the prevalence of pre-malignant and malignant skin lesions and to determine the sensitivity and specificity of screening tests. A cross-sectional population-based study was carried out using 48 census tracts randomly selected from urban zone of southern, Brazil. A total of 2,112 dwellings were visited and 1,292 individuals aged 50 years or more were interviewed. The questionnaire consisted of specific questions about new skin lesions in the last six months and/or the presence of lesions on exposed areas. Those who answered affirmatively were referred to the university's outpatient clinic for medical skin examination (gold standard). For assessing specificity the same doctors investigated a sub-sample of those who replied negatively to the questionnaire. The prevalence of pre-malignant and malignant skin lesions was 20.7%. The screening sensitivity was 20.1%, specificity 86.9%, positive predictive value 29%, negative predictive value 80.4%, and accuracy 72.9%. Using different cut-off points, the maximum sensitivity value was 38.8% and specificity remained almost the same. The study showed a high prevalence of skin lesions both pre-malignant and malignant in adults. Skin lesion screening revealed low sensitivity and unsatisfactory specificity, regardless the cut-off points set.

The relationship between exposure to arsenic concentrations in drinking water and the development of skin lesions in farmers from inner Mongolia, China

Associations between the concentration of arsenic naturally occurring in drinking water and the development of skin lesions in people have been documented for some years at various locations around the world. Data on the exposure-response relationship between concentrations of arsenic in drinking water and prevalence of skin lesions in farmers from five locations in Inner Mongolia, China have been collected from the original publications and re-analysed together as a meta-study. The calculated data show a positive linear exposure-response relationship without a threshold. The reasons for this linear correlation are discussed and compared with the data from Xinjiang, another arsenism area located in a different geographical area of China. Here a different relationship was recorded that involved a threshold concentration before skin lesions developed. The significance of these two different exposure-response scenarios is discussed.

Arsenic-induced skin lesions among Atacameño people in Northern Chile despite good nutrition and centuries of exposure.

It has been suggested that the indigenous Atacameño people in Northern Chile might be protected from the health effects of arsenic in drinking water because of many centuries of exposure. Here we report on the first intensive investigation of arsenic-induced skin lesions in this population. We selected 11 families (44 participants) from the village of Chiu Chiu, which is supplied with water containing between 750 and 800 microg/L inorganic arsenic. For comparison, 8 families (31 participants) were also selected from a village where the water contains approximately 10 microg/L inorganic arsenic. After being transported to the nearest city for blind assessment, participants were examined by four physicians with experience in studying arsenic-induced lesions. Four of the six men from the exposed village, who had been drinking the contaminated water for more than 20 years, were diagnosed with skin lesions due to arsenic, but none of the women had definite lesions. A 13-year-old girl had definite skin pigmentation changes due to arsenic, and a 19-year-old boy had both pigmentation changes and keratoses on the palms of his hands and the soles of his feet. Family interviews identified a wide range of fruits and vegetables consumed daily by the affected participants, as well as the weekly intake of red meat and chicken. However, the prevalence of skin lesions among men and children in the small population studied was similar to that reported with corresponding arsenic drinking water concentrations in both Taiwan and West Bengal, India--populations in which extensive malnutrition has been thought to increase susceptibility.

Aphanomycesas a Cause of Ulcerative Skin Lesions of Menhaden from Chesapeake Bay Tributaries

During the summer and fall of 1997, an unusually high prevalence of skin lesions in fishes from Chesapeake Bay tributaries as well as two fish kills in the Pocomoke River stimulated significant public concern. Atlantic menhaden Brevoortia tyrannus were the most frequent target of the acute fish kills and displayed skin lesions that were attributed to the presence of the toxic dinoflagellate Pfiesteria piscicida. Hence, the penetrating skin ulcers so commonly found in this species are now widely viewed by the general public and some scientists as Pfiesteria-related and to be caused by exposure to Pfiesteria toxin. We examined, histologically, 121 menhaden with these ulcers collected from both Maryland and Virginia waters of the Chesapeake Bay in 1997 and 31 from the Pocomoke and Wicomico rivers in 1998. All of the deeply penetrating ulcers, as well as raised lesions (with or without eroded epithelium), were characterized by deeply penetrating fungal hyphae surrounded by chronic, granulomatous inflammation. These lesions had an appearance identical or similar to epizootic ulcerative syndrome (EUS), an ulcerative mycotic syndrome of fishes in other parts of the world caused by the fungal pathogen Aphanomyces invadans. They were also identical to ulcerative mycosis of menhaden previously reported along the Atlantic coast of the USA as associated with Aphanomyces spp. In 1998, using methods for isolation of A. invadans, we were able to culture from affected menhaden an Aphanomyces sp. that by preliminary tests is similar or identical to A. invadans. We believe these findings suggest that factors other than Pfiesteria toxin need to be considered as the cause or initiator of these lesions.

Efficiency and cost of strategic use of acaricide for tick control in N'Dama cattle in The Gambia.

The efficiency of strategic and strategic/selective applications of flumethrin spray formulation for controlling ticks were assessed, respectively, in two groups of fourteen N'Dama cattle (Group S and Group S/S) by comparison of the number of feeding ticks with thirteen untreated N'Dama cattle (Group U) over a period of 11 months (June 1996 to April 1997). During the expected peak of tick abundance, acaricide was applied fortnightly on the whole body in animals in Group S and only on the most infested body areas in cattle in Group S/S. Weight changes and skin lesions, directly associated with tick attachment, were recorded in cattle in the three groups. The costs of the two tick control schemes were estimated. Maximum level of ticks, all species together, feeding on cattle was observed in the rainy season. Both in Group S/S and Group S, cattle carried a lower (P < 0.001) number of feeding ticks than animals in Group U over the whole study period. Percentage of tick control, over the entire period of tick investigation, was satisfactory in both acaricide-treated groups, reaching 61.2 and 75.2% in Groups S/S and S, respectively. However, the proportion of control varied according to tick species or genus. Significantly lower prevalence of skin lesions was observed on the ano-genital and udder region in cattle in Group S/S (P < 0.05) and Group S (P < 0.01) in comparison with cattle in Group U. Mean amount of acaricide solution used and relative estimated cost of treatment in cattle in Group S/S were, respectively, 25- and 14-fold lower than those in cattle in Group S. At the end of the study, animals in Groups S/S and S were, respectively, 7.2 and 15.9 kg heavier than animals in Group U. The difference was statistically significant (P < 0.02) only between Groups S and U. However, the efficiency, low cost and derived benefits of the strategic/selective acaricide application scheme indicated that it might be the most cost effective.

Administration of moxidectin for treatment of sarcoptic mange in a flock of sheep

The treatment of a large flock (1529 sheep) infested with Sarcoptes scabiei is reported. All sheep of the flock were treated twice, 12 days apart, with moxidectin 1% injectable solution, given subcutaneously at 0.2 mg kg −1 bodyweight. Skin lesions were scored on a 0 to 4 scale and skin scrapings were obtained to detect presence of mites. Prevalence of skin lesions was 10.5% before the first injection; 19, 26, 40, 68, and 96 days later, it was reduced to 6.3%, 5.3%, 3.2%, 0.7% and 0%, respectively. Mean lesion score was 0.183 before the first injection; 12, 19, 26, 40, 68 and 96 days later, it was reduced to 0.144, 0.082, 0.064, 0.038, 0.007 and 0.000, respectively. Mites were isolated from 80% of sheep sampled before treatment, from 40% of sheep sampled 12 days after the first injection and from 10% of sheep sampled 19 days after it; no mites were isolated thereafter. It is concluded that the above treatment regime completely cured sarcoptic manage. Furthermore, it is underlined that a health improvement observed after the first injection should not encourage the omission of the second one and that lack of complete healing of the skin lesions should not be interpreted as persistent infection.

Risk factors for skin lesions in Atlantic salmon, Salmo salar L.

Risk factors for skin lesions observed on the slaughter line in Atlantic salmon, Salmo salar L., were examined in a cohort study in Hordaland County, Norway. The salmon were followed from seawater introduction, starting in April 1994, until the last group was slaughtered in February 1996. The findings indicated that the egg and smolt stages were important factors in the prevalence of skin lesions at slaughter. There appeared to be differences in the risk for skin lesions between salmon from different egg suppliers to the smolt farms. An increase of 3 months between vaccination and seawater introduction increased the relative risk (RR) for skin lesions (RR = 1.9). Salmon vaccinated with a vaccine with adjuvants derived from plant oil appeared to be at higher risk for skin lesions (RR = 4.6) than those vaccinated with a vaccine with adjuvants derived from mineral oil (RR = 1.4). The larger the salmon (from 3.1 to 5.7 kg), the lower the risk for skin lesions (RR = 0.4).

Arsenic levels in drinking water and the prevalence of skin lesions in West Bengal, India.

A cross-sectional survey was conducted between April 1995 and March 1996 to investigate arsenic-associated skin lesions of keratosis and hyperpigmentation in West Bengal, India, and to determine their relationship to arsenic water levels. In all, 7683 participants were examined and interviewed, and the arsenic levels in their drinking water measured. Although water concentrations ranged up to 3400 microg/l of arsenic, over 80% of participants were consuming water containing <500 microg/l. The age-adjusted prevalence of keratosis was strongly related to water arsenic levels, rising from zero in the lowest exposure level (<50 microg/l) to 8.3 per 100 for females drinking water containing >800 microg/l, and increasing from 0.2 per 100 in the lowest exposure category to 10.7 per 100 for males in the highest exposure level (> or =800 microg/l). However, 12 cases with keratosis (2 females and 10 males) were drinking water containing <100 microg/l of arsenic. Findings were similar for hyperpigmentation, with strong dose-response relationships. Among those with hyperpigmentation, 29 cases were exposed to drinking water containing <100 microg/l. Calculation by dose per body weight showed that men had roughly two to three times the prevalence of both keratosis and hyperpigmentation compared to women apparently ingesting the same dose of arsenic from drinking water. Subjects who were below 80% of the standard body weight for their age and sex had a 1.6 fold increase in the prevalence of keratoses, suggesting that malnutrition may play a small role in increasing susceptibility. The surprising finding of cases who had arsenic-associated skin lesions with apparently low exposure to arsenic in drinking water needs to be confirmed in studies with more detailed exposure assessment. Further research is also needed concerning susceptibility factors which might be present in the exposed population.

A case of parasite-mediated competition? Phenotypic differentiation among hookworms Uncinaria sp. (Nematoda: Ancylostomatidae) in sympatric and allopatric populations of South American sea lions Otaria byronia, and fur seals Arctocephalus australis (Carnivora: Otariidae)

Hookworms in otariids are considered to meet the conditions and to fulfill the predictions set forth in the theoretical literature to define a likely case of host coexistence mediation by a shared pathogen. The intensity of infections, the prevalence of skin lesions and the morphometry of hookworms Uncinaria spp. were examined in South American sea lions and fur seals sampled along the Chilean and the Uruguayan coasts in spring and summer 1981 to 1991. In sympatric host populations from Uruguay, there were clear differences in intensity of infections, prevalence of skin lesions, and body size of the hookworms from the two host species. Sea lions from Chile, allopatric to fur seal populations, are less intensively infected and hookworms found in these sea lions have the smallest body size reported in otariids, while those from South American fur seals are the largest. Hookworms found in sea lion pups from populations sympatric to fur seals revealed intermediate values in intensity and in body size, and the sea lion pups had the highest prevalence of skin lesions. Other reports of hookworms in otariids show intermediate morphometry, following a general linear trend of differentiation in size. Consequently, they are considered to belong to the same, widely distributed species Uncinaria lucasi Stiles, 1901.

A statistical assessment of orthodontic practices, product usage, and the development of skin lesions

Recently there has been great interest in skin lesions on the hands of orthodontic personnel who are exposed to a wide variety of metals, bonding agents, and other materials. Thus this 1985 national survey of 448 Canadian orthodontists (response rate 49%) was undertaken to examine orthodontic practice activities, bonding agent and wire product use, and prevalence of skin lesions on the hands and their possible association with these products. About 13% of the 213 responding orthodontists and at least one other staff member in 18% of the orthodontic practices reported the occurrence of hand lesions (reactions) over the preceding 3 years typical of exposure to dental materials. In nearly one fourth of the offices, at least one person was affected. Regarding product use. Concise, Mono-Lok, and Endur bonding agents and stainless steel, Nitinol, and Elgiloy wires were used most often. The orthodontists reported frequent involvement in bonding activities and infrequent use of gloves. Of all the individual and combined materials and practice characteristics and activities tested singly and multivariately for statistical association with hand lesions, only the orthodontists' use of Mono-Lok, gloves, and the activity of frequently cleaning excess bonding agent were statistically related to the lesions. Multiple logistic regression suggested that the statistical effects of Mono-Lok use and removal of excess bonding agent were independent; thus removal of excess agent may have consequences for lesion development separate from Mono-Lok use.

Diet and high risk of stomach cancer in Shandong, China

The associations between arsenic exposure, arsenic methylation, and the prevalence of skin lesions and hypertension are investigated. The results indicate that the HS (hypertension and skin lesions) group and the S (skin lesions) group have higher urinary concentrations of iAs (inorganic arsenic), MMA (monomethylarsonic acid), DMA (dimethylarsinous acid) and%MMA, and lower SMI (secondary arsenic methylation index) compared to the H (hypertension) and N (without both hypertension and skin lesions) groups. The arsenic content in water which caused H may be lower than that which caused HS and S. In addition, the odds ratios suggest that higher urinary concentrations of iAs and MMA, %iAs, %MMA and PMI elevate the prevalence of only hypertension and skin lesions, and both hypertension and skin lesions. However, higher%DMA and SMI, and lower%MMA increase the prevalence of both hypertension and skin lesions compared to that of only skin lesions. It can be concluded that skin lesions subjects have higher prevalence of hypertension. Hypertension subjects may have higher prevalence of skin lesions. Lower%DMA and SMI, higher%iAs, %MMA and PMI enhance the prevalence of only hypertension and skin lesions, and both hypertension and skin lesions. Moreover, iAs and MMA may have higher toxicity and lead to both hypertension and skin lesions than to only hypertension.

Prevalence of acanthosis nigricans in an unselected population

The intent of this study was to determine, in an unselected population, the prevalence of the hyperinsulinemia-associated skin lesion, acanthosis nigricans. The posterior neck of every child in the sixth and eighth grades of the public schools of Galveston, Texas, was personally examined by the investigators during a state-mandated school health survey. A total of 1,412 children were examined. The data for each child examined included the absence or presence of acanthosis nigricans, height, weight, age, sex, and ethnic background. A subset of the children with the skin lesion also had fasting plasma insulin levels measured. Acanthosis nigricans was present in 7.1% of the 1,412 children examined. The skin lesion was equally distributed between boys and girls and was most common among children with severe obesity. The condition was present in two of 440 white non-Hispanics, 19 of 343 Hispanics, and 80 of 601 blacks examined. The fasting plasma insulin concentrations measured in some of these children and in previously evaluated subjects strongly correlate with the presence and severity of the acanthosis nigricans skin lesion. This skin lesion is much more common than previously believed and has a dramatic ethnic predisposition. We conclude that the high prevalence of this skin lesion further suggests that insulin resistance and hyperinsulinemia, with all of their serious medical implications, are also highly prevalent.