Short-term skin reactions associated to sleeve gastrectomy in eight patients

Resolution of confluent and reticulated papillomatosis after bariatric surgery

Confluent and reticulated papillomatosis (CARP), a rare dermatologic disorder characterized by hyperpigmented papules that subsequently develop into plaques with reticulated margins, is frequently confused with acanthosis nigricans. The aetiology and pathogenesis of CARP is not yet fully understood, but it is often present in individuals with obesity and PCOS. This case report describes an African American adolescent female with obesity with a rash diagnosed as CARP after unsuccessful treatment with antifungals and corticosteroids. Her dermatosis proved recalcitrant to antibiotics and metformin but started to resolve immediately after bariatric surgery. This case report supports insulin resistance as a contributor to CARP's pathogenesis and as well as its association with obesity. Clinically significant weight reduction should be considered in the management of this challenging skin condition.

Peculiar Skin Rash After Laparoscopic Sleeve Gastrectomy

BACKGROUND Obesity is one of the leading causes of preventable death worldwide. Due to its increasing incidence and the difficulty in reducing its morbidity and mortality using nonsurgical methods, the demand for bariatric surgery has risen in recent times. Sleeve gastrectomy is one of the most common types of bariatric surgery, and like any other surgery, it carries a series of risks. CASE REPORT Although complications such as gastrointestinal leaks are widely reported, there is limited literature available on cutaneous complications. Here, we report 4 cases of patients showing a peculiar skin rash 2-4 weeks following sleeve gastrectomy. We also discuss some of the mechanisms that may underlie this correlation. CONCLUSIONS There is a need for further epidemiological studies to determine the prevalence of this rash. Further studies are also needed to determine the exact etiology of this rash.

Phrynoderma and acquired acrodermatitis enteropathica in breastfeeding women after bariatric surgery

BACKGROUND AND OBJECTIVES

Women who have undergone bariatric surgery are susceptible to nutritional deficiencies in subsequent pregnancies. We highlight the importance of dermatologists in the early recognition of cutaneous signs of malnutrition occurring in this specific clinical setting.

PATIENTS AND METHODS

We compare clinical characteristics of two young women with dermatological signs of combined post-gestational nutritional deficiencies following Roux-en-Y gastric bypass surgery.

RESULTS

Patient 1 exhibited follicular papules on the extremities, perianal eczema, perlèche, alopecia, and depigmentation of hair. Patient 2 showed erythematous plaques in genitoanal and acral areas, perlèche, diffuse alopecia, and depigmentation of hair. Based on clinical and histopathological findings, decreased vitamin A (patient 1) and zinc levels (patient 2), we diagnosed phrynoderma and acquired acrodermatitis enteropathica, respectively. Comparison of the two patients revealed that both (i) were lacking follow-up after gastric bypass surgery, (ii) developed skin lesions as primary symptoms with (iii) mixed clinical manifestations due to combined deficiencies, and (iv) experienced initial symptoms during lactation suggesting a causal relationship.

CONCLUSIONS

Our observations highlight the potentially increased risk of women to develop post-gestational dermatological manifestations of malnutrition following bariatric surgery. The awareness of dermatologists with respect to this emerging, susceptible patient group may help avert damage to mother and child.