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Systemic Diseases and the Skin
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Jana Kazandjieva, Razvigor Darlenski, Nikolai Tsankov
In nearly one-third of the patients with malignant acanthosis nigricans, the skin changes usually occur before any clinical signs of the malignancy. Skin changes develop rapidly and are often escorted by mucous membrane involvement, seborrheic keratoses, acrochordons, and tripe palms. The malignant type is usually due to a gastric malignancy but may result from other malignancies. carcinoma uteri, hepatic carcinoma, carcinoma of the gut, ovaria, and lungs. Tumors creating AN are often very aggressive.
Obesity and Lipid Disorders
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Christine San Giovanni, Janet Carter, Elise Rodriguez
Acanthosis nigricans is a darkening in the creases of the neck, inside elbow and back of the knee. It is common in those with overweight and obesity and tends to improve/lighten with decreases in BMI. Children with acanthosis nigricans are at higher risk for developing type 2 diabetes, as it is often associated with insulin resistance.
Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
The most common cause of bacterial skin infections in relation to diabetes is Staphylococcus aureus. Fungal skin infections in diabetic patients are usually caused by Candida albicans. Diabetic blisters often occur with diabetic neuropathy. Acanthosis nigricans is the result of being very overweight or obese. Necrobiosis lipoidica diabeticorum, like diabetic dermopathy, is caused by blood vessel changes. Eruptive xanthomatosis is caused by poorly managed diabetes when there are high levels of cholesterol and fat in the blood.
Monogenic forms of lipodystrophic syndromes: diagnosis, detection, and practical management considerations from clinical cases
Published in Current Medical Research and Opinion, 2019
Camille Vatier, Marie-Christine Vantyghem, Caroline Storey, Isabelle Jéru, Sophie Christin-Maitre, Bruno Fève, Olivier Lascols, Jacques Beltrand, Jean-Claude Carel, Corinne Vigouroux, Elise Bismuth
Lipodystrophies are rare diseases, and the diagnosis is often overlooked33. LMNA-related lipodystrophy characteristics (e.g. generalized or partial fat atrophy with metabolic changes and insulin resistance) may be due to altered differentiation of adipocytes or changed fat structure34. The principal feature of FPLD2 is loss of fat, commencing at about pubertal age in women, in the buttocks, hips, limbs, and trunk, together with accumulation of fat in the axillae, back, face, labia majora, and visceral region. This distribution of fat, coupled with enhanced and well-defined musculature, means that affected women take on an android appearance. Further, phlebomegaly is often present in the upper and lower limbs, and the hands tend to be broad with small digits. Acanthosis nigricans in the axillae and neck and acrochordons, as signs of insulin resistance, are not infrequent. Women with FPLD2 frequently present with gynecologic disorders such as gestational diabetes, miscarriage, polycystic ovarian syndrome, and stillbirth35. In men, the abovementioned fat-loss changes occur later and are less evident; indeed, men with FPLD2 are typically diagnosed from female kin. Although subcutaneous lipomas are not present in all cases36, their presence should make physicians suspect FPLD2 when a background FPLD phenotype exists. The cardiovascular diversity of FPLD2 is broad and includes early atherosclerotic disease, arrhythmias, hypertrophic cardiomyopathy, and valvulopathies. Atherosclerotic disease and metabolic disturbances are less frequent in men than women with FPLD237.
Relation between cutaneous and extracutaneous complications in pediatric patients with type 1 diabetes
Published in Dermato-Endocrinology, 2018
M. I. Kamel, Y. I. Elhenawy, W. M. Saudi
Keratosis pilaris, though not considered a diabetes-related cutaneous manifestation, was significantly more common (17.5%) in patients with type 1 diabetes than in control subjects (4%) (P< 0.05). In the current study, keratosis pilaris was best correlated with xerosis (R = 0.6, p<0.01, β-coefficient = 0.71). Pruritus, localized or generalized without any skin lesions were present in 20% of cases compared to 12% in healthy controls (P<0.05). Among the diabetic cohort, the difference in prevelance of pruritis was non-significant in both patients with and without microalbuminuria (P > 0.05). Other cutaneous affection registered in the current study (acne, eczema, atopic dermatitis and pigmentary lesions) showed no difference between both patients and healthy controls. One patient showed acanthosis nigricans, the patient was male with 10 years duration of diabetes and poor glycemic control (HbA1c = 10.6%).
A new type of familial partial lipodystrophy: distinctive fat distribution and proteinuria
Published in Endocrine Research, 2018
Banu Yurekli, Nilufer Ozdemir Kutbay, Canan Altay, Sadiye Mehtat Unlu, Sait Sen, Huseyin Onay, Tahir Atik, Baris Akinci
The index case was a 35-year-old female patient (subject-1) who presented to our endocrine clinic with poorly controlled diabetes despite being treated with metformin 2 g/day and gliclazide 60 mg/day. Lipoatrophy was remarkable on her extremities, and her musculature was prominent. Abdominal sc fat was decreased. She appeared to have a slight increase in facial fat. Her body mass index (BMI) was 19.5 kg/m2. Acanthosis nigricans was visible on the neck and axillary region. She reported that she first noticed fat loss on her extremities when she was 16 years old. She was diagnosed with hypertriglyceridemia when she was 33. She did not report any history suggestive of any previous autoimmune diseases. Her C3 level was 124 mg/dL (90–180). She reported having had irregular menstrual cycles since the onset of puberty. She previously had one miscarriage. Polycystic ovaries (PCO) were visible on US. Hepatic steatosis was detected. Partial lipodystrophy was demonstrated on WB-MRI (Figure 1A and B). Proteinuria was detected on a urine test, although there was no sign of diabetic retinopathy. Her blood pressure was within normal limits. Her diabetes treatment was switched to metformin and intensive insulin (insulin aspart 16 units three times a day and insulin detemir 22 units once a day). Fenofibrate 267 mg/day was started for hypertriglyceridemia. An angiotensin-converting enzyme inhibitor (ACEI) (ramipril 5 mg/day) was prescribed to treat her proteinuria. The patient’s renal function remained stable in the short term, and the level of proteinuria decreased from 890 to 674 mg/day 9 months after treatment with ACEI.