Association between acrochordons and colonic polyps

Fifty-four male and female patients with suspected colonic disease were examined for the presence of acrochordons prior to colonoscopy. Thirty-five of these patients (65%) had skin tags and twenty-six (48%) were found to have colonic polyps. In this study patients with acrochordons were significantly (p less than 0.005) more likely to have adenomatous polyps; thus, skin tags may be good markers for the presence of polyps in patients with suspected colonic disease. However, any association between colonic polyps and acrochordons in the general population requires further examination.     

Skin tags: localization and frequencies according to sex and age

The relevant literature does not contain detailed numerical data about skin tags. We found 46% skin tag carriers in 750 unselected persons (25% males and 21% females). The risk of getting skin tags increases with age. The age of 50, however, seems to be a turning point, at which a stagnation of the increase is observed. The majority of the carriers had no more than 3 tags per localization; the most frequent localization was the axilla, followed by the neck. This study supplies objective data for the evaluation of skin tags as markers for colonic polyps and may provide standard values for future studies.     

Skin tag as a cutaneous marker for impaired carbohydrate metabolism: a case-control study

BACKGROUND: Skin tags are common benign skin tumors usually occurring on the neck and major flexors of older people. A possible association with impaired carbohydrate metabolism has been suggested in previous studies, but the results are not conclusive. OBJECTIVE: To investigate and compare the prevalence of diabetes and impaired glucose tolerance (IGT) in patients with skin tag and a control group. PATIENTS AND METHODS: A case-control study was conducted in individuals over 15 years old, comparing cases (n = 104) with at least three skin tags and age-, sex-, and body mass index (BMI)-matched controls (n = 94) without skin tag. Cases and controls were recruited from patients consecutively seen at an academic outpatient dermatology clinic. All patients underwent a standard 2-h oral glucose tolerance test with 75 g glucose. RESULTS: Patients with skin tag had higher frequency of diabetes than the control group (23.07% vs. 8.51%, chi(2)-test, P = 0.005). The difference in the frequency of IGT was not significant (13.46% vs. 10.63%, chi(2)-test, P = 0.543). There was a positive correlation between the total number of skin tags and the mean fasting plasma glucose (Pearson correlation, r = 0.260, P = 0.031); patients with more than 30 skin tags were particularly at an increased risk of diabetes (52.0%). No correlation was found between the number of skin tags and BMI. We did not find any correlation between the anatomical localization of skin tags and impaired carbohydrate metabolism, except for skin tags under the breast in women. CONCLUSION: These results show an increased risk of diabetes mellitus in patients with multiple skin tags. With regard to the importance of early diagnosis of diabetes, we recommend a high level of suspicion for impaired carbohydrate metabolism in patients with skin tag.     

Assessment of serum leptin,insulin resistance and metabolic syndrome in patients with skin tags

Background Skin tags are common cutaneous lesions with an indefinite aetiology. Objectives To assess serum leptin, insulin resistance and metabolic syndrome in different body mass index (BMI) patients with skin tags. Methods Three equally distributed groups of patients with multiple skin tags: 30 normal BMI, 30 overweight and 30 obese were included. Controls were age‐, gender‐ and BMI‐matched healthy subjects. Serum leptin, insulin resistance based on homeostasis model assessment of insulin resistance (HOMA‐IR) and metabolic syndrome were assessed in all groups. Results Number and extent of skin tags increase with the increase in BMI. Highest leptin levels were found in obese patients, with significant differences when compared to normal BMI and overweight patients. Similar findings existed in controls. Significantly higher leptin levels were found in obese patients compared to obese controls. HOMA‐IR was significantly higher in all groups of patients compared to BMI‐counterpart controls. Seventy‐one per cent of patients fulfilled criteria of metabolic syndrome. Number of skin tags, leptin and HOMA‐IR were significantly higher in patients with metabolic syndrome compared to patients without the syndrome. Positive correlations were found between serum leptin and HOMA‐IR in obese patients and obese controls. Positive correlations were also found between number of skin tags and waist circumference in all groups of patients. Conclusions Serum leptin displays an association with obesity and insulin resistance. Assessment of HOMA‐IR in patients with skin tags may serve as a useful approach for diagnosis of insulin resistance. Waist circumference is the only criteria of metabolic syndrome that correlates with number of skin tags.     

Dermatosis en pacientes con sobrepeso y obesidad y su relación con la insulina

IntroductionThe prevalence of obesity has increased worldwide in recent years. Some authors have described skin conditions associated with obesity, but there is little evidence on the association between insulin levels and such disorders.ObjectiveTo describe the skin disorders present in overweight and obese patients and analyze their association with insulin levels.Material and methodsThe study included nondiabetic male and female patients over 6 years of age who were seen at our hospital between January and April 2011. All the patients were evaluated by a dermatologist, who performed a physical examination, including anthropometry, and reviewed their medical history and medication record; fasting blood glucose and insulin were also measured. The patients were grouped according to degree of overweight or obesity and the data were compared using analysis of variance or the χ² test depending on the type of variable. The independence of the associations was assessed using regression analysis.ResultsIn total, 109 patients (95 adults and 13 children, 83.5% female) were studied. The mean (SD) age was 38 (14) years and the mean body mass index was 39.6 ± 8 kg/m². The skin conditions observed were acanthosis nigricans (AN) (in 97% of patients), skin tags (77%), keratosis pilaris (42%), and plantar hyperkeratosis (38%). Statistically significant associations were found between degree of obesity and AN (P = .003), skin tags (P = .001), and plantar hyperkeratosis. Number of skin tags, AN neck severity score, and AN distribution were significantly and independently associated with insulin levels.ConclusionsAN and skin tags should be considered clinical markers of hyperinsulinemia in nondiabetic, obese patients.     

Skin tags and atherosclerotic risk factors

An association between skin tags and insulin resistance, obesity, impaired carbohydrate and lipid metabolism has been suggested. However, there still is a need for comprehensive and controlled clinical studies. We aimed to evaluate the atherogenic risk factors in patients with skin tags. Thirty-six patients with skin tags who were admitted to the dermatology department and 22 healthy controls were included in this study. Possible subjects who were taking systemic drugs or who had a systemic disease that may be associated with lipid or carbohydrate metabolism abnormalities were excluded from the study. All the measurements were completed in 26 patients. Standard oral glucose tolerance tests were performed on the patient and control groups. Serum insulin, total cholesterol, triglyceride and HDL-cholesterol levels were measured. LDL-cholesterol and VLDL-cholesterol ratios and HOMA-IR and body mass indices were calculated. The mean levels of body mass index, HOMA-IR, and total cholesterol were significantly higher in patients than in controls. In conclusion, skin tags may not be innocent tumoral proliferations; instead, follow-up of such patients with regard to the development of diseases associated with atherosclerosis may be beneficial.     

Is contact allergy to disperse dyes and related substances associated with textile dermatitis?

Background  Disperse dyes (DDs) are the most common sensitizers among textile dyes, but there is little knowledge of the clinical relevance of positive patch test reactions.
Objective  To investigate if patient-reported textile-related skin problems can be explained by contact allergy to eight different DDs and/or to chemically related substances, by occupation or by atopic constitution, and if the skin problems are influenced by age or sex.
Methods  A questionnaire on textile-related skin problems was answered by 858 of 982 consecutively patch tested patients in Malmö, Sweden and in Leuven, Belgium. The baseline series used for patch testing was supplemented with a textile dye mix (TDM) consisting of the eight DDs and with the separate dyes. The association between textile-related skin problems and contact allergy to the DDs and other risk factors was investigated using multiple logistic regression analysis.
Results  Eighteen per cent of the patients suspected textiles as a cause of their skin problems. Atopic constitution and female sex were risk factors for skin reactions. Synthetic materials were the most common textiles to give skin problems. A significant association was found between self-reported textile-related skin problems and contact allergy to para -phenylenediamine (PPD) [adjusted odds ratio (OR) 2·1; 95% confidence interval (CI) 1·0–4·3]. A similar, but more imprecise, adjusted OR was found for TDM (OR 1·9; 95% CI 0·57–5·6). Contact allergy to black rubber mix was too rare to be evaluated.
Conclusions  Contact allergy to PPD was a more prevalent indicator for skin reactions to textiles than the TDM used in this study.     

Skin color of Koreans: statistical evaluation of affecting factors

BACKGROUND: The L*a*b* three-dimensional coordinate system is the most popular system used to measure skin color. The purpose of this study was to collect standard quantified data on Korean skin color using a chromameter CR-300, and to investigate the relationships among skin color and the general and individual factors that affect it. METHODS: The 600 subjects used in this study were selected using a three-stage proportionate stratified and quota sampling method. We examined the color of 12 body parts of each subject and calculated the E* value (total color difference between two objects). This study also analyzed factors that may affect skin color. RESULTS: The average L*a*b* values for the 12 body parts were 61.7462, 9.5618 and 17.0778, respectively. The site of lightest skin was the medial arm (L=63.9249), whereas the darkest was on the forehead (L=58.0044). Redness was highest on the cheek (a=11.8694) and lowest on the medial arm (a=8.1844). Skin color was lighter and more yellow in females than in males, whereas redness was higher in males. In the case of total color difference between two specific sites, the medial upper arm and forearm were the most similar (E=3.23), and the forehead and medial upper arm were the most different in color (E=7.99). CONCLUSION: The factors that significantly (P<0.01) influenced L* were sex, work place and sunbathing, factors that influenced a* were sex, work place and smoking; and the factors that influenced b* were sunbathing and age.     

The effect of obesity on skin disease and epidermal permeability barrier status in children

Abstract: Obese adult patients have many dermatoses, such as skin tags, candida infection, cellulite, and intertrigo, but only limited data have been published on obese children and the barrier function of their skin. Sixty‐five overweight and obese children (n = 40, BMI 85th–95th percentile; n = 25, BMI > 95th percentile) (aged 8–15; mean age 11.6) and 30 normal‐weight controls (aged 7–15; mean age 11.1) underwent a clinical evaluation and calculation of transepidermal water loss (TEWL). Higher weight percentile was associated with a higher incidence of some dermatoses. Skin tags were found in 40% of subjects in the 95th percentile and 2.5% of those in the 85th percentile. Striae distensae were observed in 32% of patients in the 95th percentile and 22.5% of those in the 85th percentile. Plantar hyperkeratosis was observed only in 20% of the 95th percentile subjects and was not observed in the other groups. TEWL values at the forearm site were significantly higher (p < 0.05) in obese children than in the control group, but no significant differences in TEWL values according to BMI level were found between the two groups of obese children. Degree of obesity influences the incidence of some associated dermatoses; skin tags, striae distensae, and plantar hyperkeratosis were more frequent in children in the 95th percentile of BMI. Obesity increases the TEWL rate, suggesting that obese children might become more easily overheated as weight increases, with more profuse sweating because of the thick layers of subcutaneous fat.     

Linear seborrheic keratoses associated with underlying malignancy

A clinical syndrome, consisting of eruptive linear seborrheic keratoses associated with adenomatous colonic polyps (malignant but without invasion of the stalk) and/or frankly invasive colonic adenocarcinomas, is described in five patients. Partial to almost complete regression of the cutaneous lesions over the succeeding months to years was noted after removal of the internal malignant tumors in all five patients. Resolving lesions were characterized by an accentuation of chronic inflammatory infiltrate both within the epidermis and dermis, suggesting perhaps that the regression of the skin lesions may be related to enhanced immunologic response concomitant with the removal of the underlying malignancy.     

SERUM LEPTIN, ATHEROGENIC LIPIDS AND GLUCOSE LEVELS IN PATIENTS WITH SKIN TAGS

Aim:

To investigate the relationship between serum leptin, atherogenic lipid and glucose levels in patients with skin tags and healthy controls.

Materials and Methods:

A total of 58 patients, with at least three skin tags, aged 24 to 85 years, and 31 healthy controls aged 30 to 70 years, were examined in the present study. The subjects in all the groups were selected with statistically similar Body Mass Index (BMI). Fasting concentrations of plasma glucose, serum lipids including triglyceride, total cholesterol, and high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL), HbA1c, and leptin were measured by enzyme-linked immunosorbent assay (ELISA). In addition, serum LDL level was calculated using Friedewald''s formula.

Results:

There was no significant difference in age, sex, BMI, HbA1c, triglyceride, HDL and leptin levels between the groups. Skin tags group showed significantly higher levels of total cholesterol and LDL, when compared with the healthy controls groups (P < 0.01). In addition, regression analysis showed that leptin level was positively correlated to serum triglyceride level (r = 0.265, P = 0.044).

Conclusion:

Total cholesterol and LDL serum levels should be controlled in patients with skin tags. On the other hand, glucose, leptin and HbA1c serum levels may not be as important as is being considered in recent times.     

The inflammatory response to anthralin

The inflammatory dose-response of the skin to topical anthralin was measured in patients with psoriasis, and compared with the response in a group consisting of normal subjects and patients with unrelated skin diseases. Wide individual variation was demonstrated but there was no significant difference between individuals with and without psoriasis nor was there any significant association with age, sex, skin type and original thickness or cigarette smoking.     

Hereditary non-polyposis colorectal cancer associated with disseminated superficial porokeratosis. Microsatellite instability in skin tumours

A 73-year-old man presented with typical lesions of disseminated superficial porokeratosis (DSP) and multiple seborrhoeic keratoses on his face, trunk and extremities, and later developed a keratoacanthoma on his lip. He belonged to a cancer-prone pedigree susceptible to colonic, uterine and other internal cancers, and had a personal history of early gastric cancer and advanced adenocarcinoma of the descending colon without adenomatous polyps at age 59 years. Polymerase chain reaction amplification of skin samples for seven separate microsatellite polymorphisms revealed microsatellite instability (MSI) at multiple loci in five of six seborrhoeic keratoses and the keratoacanthoma, strongly suggesting underlying defects in DNA mismatch repair. Although no germline mutations in two mismatch repair genes hMSH2 and hMLH1 were found, our patient was recognized as having hereditary non-polyposis colorectal cancer (HNPCC) based on the family history and the findings of the microsatellite analysis of skin tumours. This confirmed the usefulness of detection of MSI in prevalent and readily accessible skin lesions, including non-sebaceous non-dysplastic tumours such as seborrhoeic keratosis in the screening of HNPCC families. Although DSP may also be inherited as an autosomal dominant condition, this particular skin disease appeared to be sporadic in our patient and, to our knowledge, no association of DSP or other forms of porokeratosis with HNPCC has previously been reported. In contrast to the seborrhoeic keratoses and keratoacanthoma, no MSI was observed in two samples from DSP lesional epidermis examined.     

Dermatologic Complications in Colostomy and Ileostomy Patients

This study was designed to determine the prevalence and type of peristomal skin complications in ileostomy and colostomy patients. The influence of sex, race, age, and stoma location as possible risk factors for developing these conditions was examined. A chart review in combination with a telephone survey was conducted. The population included all ileostomy and colostomy patients (362) who had their procedure between January 1, 1984 and December 31, 1985 at the Mt. Sinai Hospital in New York. Ninety-three patients were ultimately surveyed. There were 58 ileostomy and 35 colostomy cases. This study concluded that there may be a direct relationship between age and peristomal skin problems; gender is not a risk factor for acquiring these conditions in ileostomy (p greater than 0.7) or colostomy (p greater than 0.3) patients; most patients seek the enterostomal therapist for treatment of peristomal skin problems; and the most common peristomal skin condition is minor to moderate skin irritation with redness. It is recommended that both the health professional managing the ostomy patients, and the ostomy patients themselves, receive more education concerning the techniques and the importance of proper stoma care. Future studies examining the role of the dermatologist with regard to these problems are recommended.     

Prevalence and determinants of seborrheic dermatitis in a middle‐aged and elderly population: the Rotterdam Study

Seborrheic dermatitis is a common skin disorder occurring on the scalp, face and chest and is characterized by inflammation and a greasy scaling. It is not clear what causes seborrheic dermatitis, but it is thought that overgrowth of Malassezia yeasts contributes to developing seborrheic dermatitis. Several other factors have been associated with the disease as well; age, sex, obesity, skin colour, stress, depression, education level, hypertension, climate, xerosis cutis, alcohol and tobacco use have all been associated with seborrheic dermatitis, but the evidence for these associations was often not conclusive. The aim of this study was to establish which lifestyle and physiological factors are associated with seborrheic dermatitis. Data from the Rotterdam Study of middle aged and elderly people from the Netherlands, was used to investigate these previously reported factors. The rationale is that knowledge about determinants could provide new insights in the pathophysiology of seborrheic dermatitis, which might lead to preventative strategies and/or new treatment regimes. In the Rotterdam study, 5,498 participants underwent a full body skin examination, of which 788 had seborrheic dermatitis. The authors found that male sex, light skin colour, winter season and a generalised dry skin increased the likelihood of having seborrheic dermatitis and that the other factors were not associated with seborrheic dermatitis. Further, the authors conducted an analysis to investigate if the gender differences could be explained by hormonal differences, but they did not find an association between hormones and seborrheic dermatitis. Of the found associations, a dry skin seems the easiest to influence. Improving the skin barrier could therefore become a target in the treatment of seborrheic dermatitis.     

Association between cutaneous melanoma, Breslow thickness and vitamin D receptor BsmI polymorphism

BACKGROUND: Literature data report an association between some vitamin D receptor (VDR) polymorphisms and different kinds of tumours, including malignant melanoma (MM). Only three VDR polymorphisms (FokI, TaqI and A-1012G) have been investigated in association with the presence of cutaneous MM or the development of metastases. OBJECTIVES: The present paper analyses for the first time the association between BsmI polymorphism and MM prevalence together with Breslow thickness. In addition, the FokI single nucleotide polymorphism was also determined. METHODS: One hundred and one patients with MM and 101 healthy donors matched for age and sex were enrolled. Molecular VDR typing was performed by means of restriction fragment length polymorphism analysis. RESULTS: All cases and controls were in Hardy-Weinberg equilibrium for BsmI, FokI and A-1012G. Significant associations were found between the BsmI bb genotype frequency and MM (P = 0.02) along with Breslow thickness (P = 0.001). This same behaviour was not observed for the FokI or A-1012G polymorphisms. Multivariate logistic regression analysis confirmed these significant results after correction for age, gender, skin type and MM localization. CONCLUSIONS: Although the biological meaning of the effects exerted by BsmI polymorphism is still under debate, the statistical association found in the present study suggests that further work should be done to verify this variant as a possible risk marker for MM and its aggressiveness, also considering that the real association may be due to other unknown genes linked to the BsmI b allele.     

Is UVB treatment of psoriasis safe? A study of extensively UVB-treated psoriasis patients compared with a matched control group

The aim of the study was to investigate whether or not extensively UVB-treated psoriatics ran a greater risk of developing skin cancer than did controls. The 85 most extensively UVB-treated psoriasis patients during recent decades have been investigated with regard to premalignant and malignant skin lesions and compared with a population matched for age, sex, and geographic region. The prevalence of persons who had or had had premalignant/malignant skin lesions was 5.9% (n = 85) in the psoriasis group, vs. 10.1% in the control group (n = 338). This difference is not statistically significant and the confidence limits are such that it is unlikely that the psoriasis patients treated in the past have an increased prevalence of premalignant and malignant skin lesions. A multiple regression analysis has been conducted among the controls, showing a correlation between premalignant/malignant skin changes and advanced age and outdoor occupations. No such correlation was found for the factors: sex, skin type, or travel to southern latitudes.     

寻常性痤疮严重度的影响因素分析

目的探讨寻常性痤疮严重度的影响因素。方法于2007年1～12月对本科门诊确诊为寻常性痤疮的1129例患者,由首诊医生向患者发放自制的流行病学调查问卷。调查内容包括13项:性别、年龄、皮肤类型、家族史、初发年龄、平时饮食喜好、每日洗脸次数、每日睡眠时间、平均每天使用电脑时间、有无便秘、哪些季节加重、女性患者月经初潮年龄、有无月经不规律。采用SAS Version8.1软件包进行χ2检验、单因素Logistic回归分析和多因素Logistic回归分析。结果单因素Logistic回归分析显示,与痤疮严重程度相关的5个因素依次为性别、痤疮初发年龄、每日洗脸次数、油性皮肤、季节。多因素Logistic回归分析结果显示与痤疮严重程度相关的依次是性别(P<0.0001)、初发年龄(P<0.05)、喜食咸味(P<0.05)、皮肤类型(P<0.05)。结论寻常性痤疮的严重程度与油性皮肤、喜食咸味明显相关;初发年龄越小,痤疮越严重;且男性患者皮损较女性患者更严重。     

Association of early-stage psoriasis with smoking and male alcohol consumption: evidence from an Italian case-control study

OBJECTIVE: To analyze the association of psoriasis with smoking habits and alcohol consumption before first diagnosis by a dermatologist. DESIGN: A multicenter case-control study. Interviews were conducted by trained medical investigators using a structured questionnaire. SETTING: Outpatient services of 10 general and 10 teaching hospitals in northern and southern Italy. SUBJECTS: Patients with a first diagnosis of psoriasis made by a dermatologist and a history of skin manifestations of no longer than 2 years after the reported disease onset. Patients with new diagnoses of skin diseases other than psoriasis were selected as control subjects. A total of 404 case patients (median age, 35 years) and 616 controls (median age, 36 years) were included in the analysis. RESULTS: The risk for psoriasis was higher in ex-smokers and in current smokers than in patients who never smoked. The relation with smoking was stronger and more consistent among women than men. In men, a significant association was restricted to the ex-smoker status. Smoking was strongly associated with pustular lesions (29 patients) with an adjusted odds ratio of 10.5 (95% confidence interval, 3.3-33.5) for those smoking more than 15 cigarettes per day. No significant overall association with alcohol consumption was documented after controlling for smoking habits. However, the risk seemed to vary according to sex, with a moderate association being documented in men. CONCLUSIONS: Cigarette smoking and, in men, alcohol consumption are associated with psoriasis. There is a strong association between smoking and pustular lesions.