Acanthosis nigricans and insulin resistance associated with hypothyroidism

An obese 15-year-old boy with a one-year history of acanthosis nigricans was found to have primary hypothyroidism, with a thyrotropin level in excess of 50 microU/mL. At the same time, he was found to have subclinical insulin resistance. Therapy with thyroxine resulted in weight loss, reversal of hyperinsulinemia, and resolution of the acanthosis nigricans. Hypothyroidism can be added to the list of endocrine diseases associated with acanthosis nigricans. This is unlikely to be a direct effect of the hypothyroid state, but may instead be an indirect action mediated through obesity and subsequent insulin resistance. Insulin resistance and hyperinsulinemia seem to be commonly associated with (and perhaps causative of) the acanthosis nigricans that is seen in many endocrine diseases.     

Malignant acanthosis nigricans associated with non-Hodgkin's lymphoma. Report of 2 cases

Two cases of malignant acanthosis nigricans associated with non-Hodgkin's lymphoma are presented. A 61-year-old negro male with a diffuse large cell non-Hodgkin's lymphoma presented extensive acanthosis nigricans, pachydermatoglyphy and florid cutaneous papillomatosis. No viral particles were observed by electron microscopic studies of the wart-like lesions. Acanthosis nigricans disappeared under chemotherapy. The second case was a 21-year-old caucasian male with non T non B diffuse large cell non-Hodgkin's lymphoma. Very few cases of acanthosis nigricans associated with non-Hodgkin's lymphoma have been reported in the literature, since to our knowledge these two are only the fourth and fifth. Pachydermatoglyphy and florid cutaneous papillomatosis are markers of malignant acanthosis nigricans.     

Malignant acanthosis nigricans and tripe palms associated with pancreatic adenocarcinoma

Malignant acanthosis nigricans is a disease that has an abrupt onset and is most commonly associated with gastric adenocarcinoma. It also has occurred as a paraneoplastic phenomenon in other carcinomas. Malignant acanthosis nigricans can occur simultaneously, before, or after the onset of internal malignancy. Malignant acanthosis on the palms is referred to as tripe palms. We describe a rare association of oral malignant acanthosis nigricans and tripe palms secondary to an underlying pancreatic adenocarcinoma.     

An association of acanthosis nigricans and Crouzon syndrome.

An 11-year-old Japanese female having acanthosis nigricans associated with Crouzon syndrome is reported. Crouzon syndrome is a craniostenotic craniofacial malformation associated with premature closure of selective calvarial sutures, exophthalmos, maxillary hypoplasia, and a beak-shaped nose. It is an autosomal dominant inherited disorder. Crouzon syndrome is one of the syndromes which may be associated with acanthosis nigricans. The association of acanthosis nigricans with Crouzon syndrome is assumed to be a rare abnormality, although the true frequency is uncertain. We have reviewed the reported cases of acanthosis nigricans associated with Crouzon syndrome and characteristics were discussed.     

Improved acanthosis nigricans with lipodystrophic diabetes during dietary fish oil supplementation

Acanthosis nigricans is well recognized in its clinical association with several types of insulin-resistant syndromes, and skin involvement is usually unresponsive to local treatment or management of diabetes. A young woman with a lipodystrophic form of diabetes, hypertriglyceridemia, and severe generalized acanthosis nigricans was placed on a diet with fat supplementation in the form of omega-3-fatty-acid-rich fish oil. She was observed to have striking improvement in the appearance and extent of acanthosis nigricans while receiving this regimen. This occurred despite continued therapy with niacin (nicotinic acid), an agent associated with acanthosis nigricanslike skin changes.     

Acanthosis nigricans in obese patients: Presentations and implications for prevention of atherosclerotic vascular disease

Acanthosis nigricans is traditionally characterized by hyperpigmented, velvety plaques of body folds. Involvement of other areas occurs as well. The condition is caused by hyperinsulinemia, a consequence of insulin resistance that occurs associated with obesity. As the frequency and degree of obesity increase in the population, a concomitant increase in acanthosis nigricans can be expected. The dermatologist has an important role in identifying the subset of obese patients with acanthosis nigricans. These patients have hyperinsulinemia and may be at greater risk of consequent atherosclerotic cardiovascular disease. It is essential for dermatologists to recognize the many presentations of acanthosis nigricans to identify patients at risk for associated medical conditions. This article illustrates a variety of presentations of acanthosis nigricans associated with insulin resistance.     

Oral acanthosis nigricans in chronic hepatitis B with a 21-year follow up

Acanthosis nigricans is a rare mucocutaneous disorder of unknown etiology that manifests as hyperpigmented velvety plaques, most often on intertriginous areas such as the neck and axillae as well as on mucosal sites such as the oral cavity. The disorder presents either as a paraneoplastic manifestation of an underlying malignancy, especially gastrointestinal adenocarcinomas or in association with obesity, administration of drugs or endocrinopathies, most commonly insulin-resistant diabetes mellitus. In the present article, a case of acanthosis nigricans with oral and cutaneous manifestations in a male patient with chronic hepatitis B infection is described. To the best of our knowledge, this is the first case of benign oral acanthosis nigricans associated with chronic hepatitis B.     

Oral acanthosis nigricans: report of a case and comparison of oral and cutaneous pathology

Malignant acanthosis nigricans is usually associated with adenocarcinomas of the digestive tract. The lesions of acanthosis nigricans commonly run a parallel course to the associated malignancy, producing hyperpigmented, roughened plaques on the skin and, sometimes, verruca-like papules on the oral mucosa. The clinical differences between cutaneous and oral acanthosis nigricans are mirrored by the marked differences in the histopathology. Because oral acanthosis nigricans is uncommon, recognizing histologic features may be difficult. The oral lesions have a true acanthosis and epithelial papillary hyperplasia while the cutaneous forms show slight irregular acanthosis that alternates with areas of epidermal atrophy and dermal papillomatosis.     

Familial acanthosis nigricans

A mother and daughter had benign familial acanthosis nigricans. Familial acanthosis nigricans begins in early childhood and may be accentuated at puberty. The eruption is not associated with underlying illness. Forms of acanthosis nigricans are associated with obesity, endocrinologic abnormalities, drug ingestion, and malignant neoplasms.     

Familial acanthosis nigricans due to K650T FGFR3 mutation

BACKGROUND: Acanthosis nigricans is a feature of several syndromes caused by activating mutations of the fibroblast growth factor receptor 3 gene (FGFR3), including Crouzon syndrome with acanthosis nigricans, thanatophoric dysplasia, and severe achondroplasia with developmental delay and acanthosis nigricans (SADDAN syndrome). OBSERVATIONS: We describe a healthy 4-year-old African American girl with generalized acanthosis nigricans since infancy. Her father had a history of acanthosis nigricans since childhood, in addition to Crohn disease, obesity, and adult-onset diabetes mellitus. A pedigree with numerous affected family members was constructed. Other than slightly short stature, no associated anomalies were found, including dysmorphic features or skeletal or neurologic defects. Genetic testing revealed a previously undescribed, heterozygous lysine to threonine mutation at codon 650 of the FGFR3 gene in the 4 affected family members who were tested. CONCLUSION: Extensive acanthosis nigricans in early childhood, especially with a family history of acanthosis nigricans, may warrant testing for FGFR3 mutations.     

Malignant acanthosis nigricans--a para-endocrine syndrome?

A case is reported of acanthosis nigricans associated with a gastric carcinoma. The gastric cancer was of the diffuse, infiltrating type. Many tumour cells were identified by means of histochemistry and electron microscopy as neoplastic enterochromaffin-like cells. It is suggested that cancers associated with acanthosis nigricans might constitute a certain group of carcinomas in which parts of the tumour cells arise from the APUD-series of endocrine cells.     

Evaluation of insulin resistance in obese women with and without acanthosis nigricans

Acanthosis nigricans is characterized by hyperpigmented velvety plaques of body folds and neck. Insulin could be a responsible factor in the pathogenesis of this condition and hyperinsulinemia: a consequence of insulin resistance stimulates the formation of these characteristic plaques. In this study, insulin resistance was compared in obese women with and without acanthosis nigricans. This was a cross-sectional study. Sixty-six obese women (32 patients with acanthosis nigricans and 34 patients without acanthosis nigricans) were selected randomly. Levels of fasting serum insulin and fasting blood glucose were measured in both groups and insulin resistance was determined using homeostasis model assessment. Glucose tolerance test also was performed for all of participants. Five (15.6%) patients with acanthosis nigricans and no (0%) patient without acanthosis nigricans had insulin resistance ( P  < 0.05). Six (18.7%) patients with acanthosis nigricans and one (2.9%) patient without acanthosis nigricans had impaired glucose tolerance test ( P  < 0.05). The mean levels of fasting serum insulin were 15.7 ± 8.7 and 12.2 ± 4.1 µm/mL ( P  < 0.05) and the mean values of insulin resistance index were 3.5 ± 1.9 and 2.6 ± 0.9 µm/mL between patients with and without acanthosis nigricans, respectively ( P  < 0.05). In Iranian obese women, acanthosis nigricans is a marker of insulin resistance.     

Malignant acanthosis nigricans and endometrioid adenocarcinoma of the parametrium: the search for malignancy

Malignant acanthosis nigricans is recognized as a cutaneous sign of internal malignancy, usually an adenocarcinoma. Although cases of malignant acanthosis nigricans have been associated with cervical, ovarian, and endometrial neoplasms, we describe a case with a rarely if ever reported association, endometrioid adenocarcinoma of the parametrium.     

Generalized acanthosis nigricans in childhood

Acanthosis nigricans in children is usually associated with obesity. Generalized acanthosis nigricans in childhood is rare. We report a 13-year-old boy with an 8-year history of generalized hyperpigmentation and velvety thickening of the skin. Despite an extensive physical and laboratory examination no evidence of underlying endocrinological or neoplastic disease was found.     

Generalized acanthosis nigricans in an otherwise healthy young child

Acanthosis nigricans in children is usually a benign condition most commonly associated with obesity. Generalized acanthosis nigricans is a very rare condition, especially in childhood. We report a 6-year-old boy with a 4-year history of generalized hyperpigmentation and velvety thickening of the skin. Despite an extensive examination, no evidence for an underlying neoplastic or endocrinologic disease was found.     

Topical therapy with tretinoin and ammonium lactate for acanthosis nigricans associated with obesity

Acanthosis nigricans (AN) is a cutaneous marker of various underlying systemic conditions. To date, no satisfactory topical therapy for this cutaneous disorder has been described. The following is a report of the successful use of a combination of 12% ammonium lactate cream and 0.05% tretinoin cream to treat AN associated with obesity.     

Acanthosis nigricans in squamous cell carcinoma of the larynx

Acanthosis nigricans maligna represents a true paraneoplastic syndrome being most frequently associated with adenocarcinoma of the stomach. We present the second case of the world literature of malignant acanthosis nigricans due to an early invasive squamous cell carcinoma of the vocal cord.     

Malignant acanthosis nigricans: potential role of chemotherapy

Acanthosis nigricans is an uncommon skin condition characterized by hyperkeratosis and skin hyperpigmentation. Most causes are benign, but it may also be associated with gastrointestinal and other malignancies. When associated with malignant disease, the skin pathology may be more severe and treatment often unsuccessful. We describe a 66-year-old man with acanthosis nigricans associated with carcinoma of the stomach, with distressing generalized cutaneous, perioral and perineal disease, whose skin condition resolved completely with combination chemotherapy. In patients with malignant acanthosis, chemotherapy may relieve many of the distressing cutaneous symptoms. A close liaison between gastroenterologists, dermatologists and oncologists is required.     

Acanthosis nigricans and "tripe palm" as paraneoplastic manifestations of metastatic tumor

Acanthosis nigricans is a common dermatosis and is most often associated with benign conditions, such as insulin resistance. It is rare as a paraneoplastic marker. As such, it is characterized by sudden onset and rapid dissemination of velvety and hyperchromic skin lesions. The term "tripe palm" refers to exaggeration of the palmar ridge pattern, which resembles the internal surface of the bovine intestinal tract. This is a paraneoplastic marker of high specificity, with 90% of the cases being associated with malignancy. We report the case of a patient with stage IV ovarian adenocarcinoma presenting acanthosis nigricans and tripe palm. Both findings are closely correlated to the neoplasm course.     

Association of acanthosis nigricans and skin tags with insulin resistance

Insulin resistance is a metabolic disorder in which target cells fail to respond to normal levels of circulating insulin. Insulin resistance has been associated with presence of acanthosis nigricans and acrochordons. It is known that early diagnosis and early initial treatment are of paramount importance to prevent a series of future complications. These dermatoses may represent an easily identifiable sign of insulin resistance and non-insulin-dependent diabetes.