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PubMedDate not supplied

Acanthosis nigricans in patients with nonalcoholic steatohepatitis: an uncommon finding.

OBJECTIVE: To determine the prevalence and the metabolic characteristics of acanthosis nigricans (AN) in a group of 28 study subjects with biopsy-proven nonalcoholic steatohepatitis (NASH). METHODS: The study participants (15 female and 13 male patients, 20 of whom were white subjects; mean body mass index, 32.7 +/- 5.7 kg/m2; mean age, 45.7 +/- 11.3 years) underwent an oral glucose tolerance test (OGTT), frequently sampled intravenous glucose tolerance test (FSIGT), and fasting metabolic panels. AN status was clinically determined, and fat mass was measured by dual-energy x-ray absorptiometry. RESULTS: All study subjects had insulin resistance (IR), and 15 (54%) had the metabolic syndrome (by Adult Treatment Panel III criteria). Of the 28 patients, 4 (14%) had AN (AN+) and 24 did not (AN-). AN+ subjects had a higher body mass index (37.7 +/- 5.6 versus 31.5 +/- 4.3 kg/m2), fat mass (38.9 +/- 4.0 versus 29.2 +/- 2.3 kg), and leptin levels (17.2 +/- 3.9 versus 9.3 +/- 1.6 ng/mL) (P<0.05). They also had significantly higher indices of insulin secretion: fasting and stimulated insulin and C-peptide levels from OGTT and FSIGT. Metabolic syndrome prevalence was 40% in AN- versus 75% in AN+ subjects (not significantly different). Although the AN+ group had significantly lower fasting and OGTT-derived indices of insulin sensitivity in comparison with the AN- group, their FSIGT indices were similar. Waist circumference (a surrogate of visceral adiposity) and cytokine profiles were similar in the AN+ and AN- groups. CONCLUSION: AN was not highly prevalent in our study cohort with NASH, despite the high prevalence of IR. Hyperinsulinemia and total adiposity, rather than visceral adiposity and IR, were the indices most predictive of AN. The use of AN as an index of IR in patients with NASH appears to have limited diagnostic value.

Acanthosis Nigricans↗
PubMed2001

Acanthosis nigricans: a new cutaneous sign in severe atopic dermatitis and Down syndrome.

Acanthosis nigricans (AN) occurs associated with many different systemic diseases, such as endocrine disorders and internal malignant neoplasms. To our knowledge, the association of AN with severe atopic dermatitis (AD) or Down syndrome has not been described before. This 82-month retrospective study included 1038 patients: AN was present in 4.9% of atopic patients and 50.9% of subjects with Down syndrome. AN was more frequent in patients with severe AD and in 100% of cases of hand dermatitis and juvenile plantar dermatosis, located on the interphalangeal and metacarpophalangeal joints, whereas in Down syndrome other flexures were also affected. The pathogenesis of AN in AD is unknown, but in Down syndrome it seems to be related to obesity. Possible insulin resistance underlyng the pathogenesis of AN in these patients is still unknown.

Acanthosis Nigricans↗
PubMed2003

Common hyperpigmentation disorders in adults: Part II. Melanoma, seborrheic keratoses, acanthosis nigricans, melasma, diabetic dermopathy, tinea versicolor, and postinflammatory hyperpigmentation.

Nevi, or moles, are localized nevocytic tumors. The American Cancer Society's "ABCD" rules are useful for differentiating a benign nevus from malignant melanoma. While acanthosis nigricans may signal an underlying malignancy (e.g., gastrointestinal tumor), it more often is associated with insulin resistance (type 2 diabetes, polycystic ovary syndrome) or obesity. Melasma is a facial hyperpigmentation resulting from the stimulation of melanocytes by endogenous or exogenous estrogen. Treatments for melasma include bleaching agents, laser therapy, and a new medication that combines hydroquinone, tretinoin, and fluocinolone acetonide. Lesions that develop on the shins of patients with diabetic dermopathy often resolve spontaneously; no treatment is effective or recommended. Tinea versicolor responds to treatment with selenium sulfide shampoo and topical or oral antifungal agents. Postinflammatory hyperpigmentation or hypopigmentation can occur in persons of any age after trauma, skin irritation, or dermatoses.

Acanthosis Nigricans↗
PubMed2005

Acanthosis nigricans.

Acanthosis nigricans is thickened, velvety, hyperpigmented skin associated with a variety of endocrine disorders, malignancies and medications.

Acanthosis Nigricans↗
PubMed2006

Comparison of metformin versus rosiglitazone in patients with Acanthosis nigricans: a pilot study.

BACKGROUND: Acanthosis nigricans (AN) is a skin condition commonly present on the neck of obese subjects. Obesity is often accompanied by insulin resistance and/or hyperinsulinemia. Metformin and rosiglitazone are 2 pharmacologic agents useful in conditions characterized by insulin resistance. OBJECTIVE: The aim of our study was to compare the efficacy of metformin versus rosiglitazone on AN lesions of the neck as well as their effects on metabolic and anthropometric variables. METHODS: This 12-week randomized, open-label pilot study involved overweight or obese subjects with AN treat with either metformin (n=4) or rosiglitazone (n=3). RESULTS: Only the rosiglitazone group showed a significant reduction in insulin levels. No effect on the severity of AN was observed, but modest improvements of skin texture occurred in both treatment groups. CONCLUSIONS: Metformin and rosiglitazone were well-tolerated. Although efficacy on skin lesions was very modest, their use in acanthotic subjects might be useful during longer treatment periods.

Acanthosis Nigricans↗
PubMed1991

Acanthosis nigricans.

Acanthosis nigricans (AN) is a dermopathy with a distinctive appearance that facilitates its diagnosis. Although an external condition, it is associated with a wide variety of less obvious internal conditions, either benign or malignant. Insulin resistance figures prominently in its benign associations and plays a primary role in its development. The development of AN in malignant conditions remains to be explained. AN rarely requires treatment, although the underlying condition usually does.

Acanthosis Nigricans↗
PubMed1989

[Systemic photochemotherapy (PUVA) in acanthosis nigricans maligna: regression of keratosis, hyperpigmentation and pruritus].

We report on a 60-year-old patient, who developed malignant acanthosis nigricans (MAN) with intense itching 2 years after a large-cell bronchial carcinoma had been diagnosed and found inoperable. The MAN became manifest at a phase of full clinical remission of the lung tumor, which had been treated with cytostasis (cisplatin, vindesine), high energy irradiation, and extirpation of the lymph node metastases. One year after onset of MAN, the lung tumor relapsed, accompanied by an elevated serum level of carcinoembryonic antigen (CEA). The patient was slightly obese, but not diabetic. The generalized MAN was treated with 18 exposures to systemic PUVA (photochemotherapy) over 9 weeks. The patient received 8-methoxypsoralene (8-MOP) orally and a total UVA dose of 52 J/cm2; the last exposure amounted to a maximum dose of 4 J/cm2. Under this treatment, the patient was completely relieved from tormenting pruritus; in addition, we observed significant regression of the pigmented keratoses as well as the intertriginous maceration.

Acanthosis Nigricans↗
PubMed1989

Peripheral muscle glucose and potassium transport in a family with acanthosis nigricans and insulin resistance.

This study was designed to determine the forearm exchange of glucose and potassium in four members of a family exhibiting acanthosis nigricans and insulin resistance. Total areas under the curves for potassium release or uptake were within the normal range in all patients. Peripheral glucose uptake, however, was normal in 3 patients and lower in one patient. In the latter patient, the dissociation observed between glucose and potassium transport suggests several manners of differential impairment of insulin action and/or steps distal to the insulin receptor as being responsible for insulin resistance.

Acanthosis Nigricans↗
PubMedDate not supplied

Insulin resistant diabetes mellitus associated with acanthosis nigricans and systemic lupus erythematosus in a Nigerian male.

A case is reported of diabetes mellitus associated with insulin resistance, acanthosis nigricans and systemic lupus erythematosus. This will be the first such case described in a Nigerian and most likely the first case in an African, of this recently characterized syndrome. An awareness about this syndrome by physicians in this environment should lead to a prompt referral to where there are adequate facilities for an early diagnosis which could prove to be life-saving.

Acanthosis Nigricans↗
PubMed1987

Familial acanthosis nigricans. A longitudinal study.

The triad of hyperandrogenism, insulin resistance and acanthosis nigricans (HAIR-AN) is known to have a familial tendency. In order to better understand the natural history and possible treatment of this disorder, we studied the clinical course of two families in which all female progeny were affected. A rapid progression of the HAIR-AN syndrome was apparent during the peripubertal period and early reproductive years. Beyond this period, the progression of HAIR-AN appeared quite variable. Rapid weight gain was a major stimulant for increasing insulin resistance and hyperandrogenemia. In the one subject with a postmenarcheal onset of the syndrome, prolonged weight reduction was associated with an improvement in the dermatologic manifestation as well as in the hyperandrogenism and insulin resistance. Oral contraceptives appear to improve the dermatologic symptoms of the HAIR-AN syndrome.

Acanthosis Nigricans↗
PubMed1979

Generalized malignant acanthosis nigricans.

We report a case of generalized malignant acanthosis nigricans (AN) secondary to metastasizing squamous cell carcinoma of the cervix uteri. The disease initially manifested in the perineum as condyloma acuminatum-like lesions. Subsequently, most of the cutaneous surface and the mucosa of the vulva, mouth, tongue, and the palpebral conjunctiva became involved. The association of AN with a squamous cell carcinoma is rare, and conjunctival involvement is unusual.

Acanthosis Nigricans↗
PubMed1979

[Acanthosis nigricans, hirsutism and insulin-resistant diabetes].

Three girls, two of them being monozygotic twins, are affected with acanthosis nigricans and hirsutism, which worsened at the time of their puberty. The first one has primary amenorrhea and the twins complain of spaniomenorrhea. Furthermore, laboratory data concluded to diabetes, hyperinsulinism and resistance to insulin. This rare association of syndromes is not accidental but its significance remains unknown.

Acanthosis Nigricans↗
PubMed1971

Acanthosis nigricans.

Four types of acanthosis nigricans (a.n.) must be distinguished: "benign" a.n., pseudo a.n., a.n. as part of a syndrome and malignant a.n. These different types affect different age groups, follow different courses, are associated with different conditions, are or are not reversible, have or do not have a genetic basis and also show great differences in regard to their significance for the patient's life or well-being.

17-Ketosteroids↗
PubMed1984

[Lipoatrophic diabetes with acanthosis nigricans. Prolonged blood glucose normalization by continuous infusion of insulin].

Insulin resistance is a permanent feature of lipoatrophic diabetes, the resistance being almost regularly stubborn. We report the case of a 23-year old unmarried woman with generalized lipoatrophy and Acanthosis nigricans. Seven years after a diabetes resistant to all treatments was diagnosed, blood glucose levels were permanently around 25 mmol/l. Multiple and severe micro- and macroangiopathies were present. Partial resistance to insulin was demonstrated. This resistance could not be explained by abnormalities in anti-insulin hormones nor by a decrease in the number or affinity of insulin receptors, which suggested an intracellular abnormality below membrane receptors. Sustained control of glycaemia at a normal level was achieved by continuous infusion of insulin in high doses. It would appear that optimum insulin therapy using an insulin pump would offer hopes of therapeutic success in this particular form of insulin resistance.

Acanthosis Nigricans↗
PubMed1983

Acanthosis nigricans in a patient with streak gonads.

Acanthosis nigricans (ACN) is associated with ovarian disorders or abnormalities of carbohydrate metabolism. We saw a 21-year-old woman who had primary amenorrhea and ACN. Results of endocrine studies showed anovulation and low serum estradiol levels with increased gonadotropin concentrations. Laparoscopic examination disclosed bilateral streak gonads; the ovaries were completely replaced by fibrous tissue. Cultures of peripheral lymphocytes, skin fibroblasts, and the right and left ovaries demonstrated normal female karyotype 46XX in all mitoses studied. An autoimmune disorder was excluded by the absence of antithyroid and antiadrenal antibodies. Specific antibodies against ovarian proteins were also absent. A glucose tolerance test demonstrated fasting hyperinsulinemia and exaggerated serum insulin response to the glucose load. The observations in this patient exclude a primary pathogenic role for the ovary in the production of ACN; they also lend further support to a connection between the cutaneous disorder and insulin resistance.

Acanthosis Nigricans↗
PubMed1983

[Case of gastric cancer associated with acanthosis nigricans and meningeal carcinomatosis].

The patient was a 61-year-old man who initially complained of skin pigmentation. He was diagnosed as malignant acanthosis nigricans associated with gastric cancer (IIc advanced) in March 1981. Surgical excision of the stomach was performed in May 1981. In July 1981 he experienced headache, vomiting and muscle weakness. A diagnosis of meningeal carcinomatosis was made based on his clinical symptoms, spinal fluid examination and a computerized tomography scan. The intraventricular administration of cytosine arabinoside, methotrexate and hydrocortisone via the Ommaya reservoir resulted in complete remission. In November 1981 the patient died of bronchopneumonia and sepsis due to pancytopenia.

Acanthosis Nigricans↗