Cutaneous manifestations in children with diabetes mellitus and obesity

Bullosis diabeticorum in a morbidly obese woman in Haiti

Bullosis diabeticorum is a rare skin complication of diabetes mellitus, characterized by sudden onset bullous lesions with no history of trauma. It predominantly affects men and has an acral asymmetric presentation. Here, we report a case of bullous disease in a diabetic patient with morbid obesity, the first described in Haiti. A 40-year-old woman, with a strong history of diabetic for five years, poorly controlled and morbidly obese presented to our emergency for bullosis lesions in her limb. She had a prior presentation about two years ago and, approximately a week before this actual presentation, the same symptomatology occurred suddenly without any trauma. After evaluation and screening, the diagnosis of bullosis diabeticorum was kept. She was initially treated with antibiotics due to signs of superinfection. However, as soon as the symptoms improved, antibiotics were discontinued. An antiseptic lotion and topical antibiotic, neomycin, were used along with daily dressings. About a week after, her blood glucose came to control, signs of infection disappeared as did the bullous lesions and surgical evaluation was performed to ensure proper wound evolution. She was educated by a nutritionist, and our team emphasized the importance of regular follow-up at the hospital. Diabetic bullous disease is very rare and easy to confuse with other diabetic skin complications. A good clinical history is essential to make the diagnosis, and management requires good therapeutic education to avoid the burdensome complications of diabetes.

Investigating the Effects of the COVID-19 Pandemic on Pediatric Body Mass Index, and Health Status in an Inner-City, Low-Income Setting

INTRODUCTION

The COVID-19 pandemic required unprecedented containment measures, including prolonged stay-at-home orders, to combat spread and prevent loss of life. One of the consequences of these mandates was the closure of schools. Children in resource-limited communities already experiencing disparities were placed at a significant disadvantage by the closure of schools. Many depended on the school systems as their primary source of nutrient-rich food. Additionally, for many, schools provide the only safe place for outdoor play and physical activity. The unintended consequences of the COVID-19 stay-at-home orders for these high-risk children are now being investigated.

METHOD

This article reports a retrospective chart review of children aged 9-11 years in a low-income, inner-city practice in a moderately sized Southeastern city. Baseline data were obtainef fro 2019 and compared to 2020 and/or 2021.

RESULTS

Findings indicate statistically significant increases in body mass index in this high-risk population of children. Additionally. chronic condistion associate with obesity were identified in many of the unhealthy weight children in the study.

DISCUSSION

This study identifies unintended consequences form the pandemic containment measures that are consistent with other emerging research related to the pandemic's effects on body mass index in children.

Cutaneous manifestations of obesity in Turkish children: A comparative study

BACKGROUND

Cutaneous changes in obese adults have been investigated in numerous studies, but this issue has not been adequately investigated in children.

OBJECTIVES

We aimed to determine the prevalence of skin manifestations in children with obesity by comparing them to normal-weight children.

METHODS

A cross-sectional study was conducted between June 2017 and January 2019 in which 82 children with obesity and 86 normal-weight healthy control children were enrolled. Study participants had detailed full-body skin examinations performed by the same dermatologist; mycological and Wood's lamp examinations were performed when necessary. Sociodemographic and anthropometric measurements of the participants were recorded.

RESULTS

Striae distensae were the most common skin manifestation in children with obesity; striae were significantly higher in the obese than in the control group (72% vs. 26.7%, p < .001). The anatomical distribution of the striae distensae in the groups differed significantly. Striae distensae were most commonly observed on the buttocks in the control group, while the thighs were the most common site in the obese group. Acanthosis nigricans (63.4% vs. 3.5%, p < .001), acrochordons (17.1% vs. 1.2%, p < .001), keratosis pilaris (32.9% vs. 17.4%, p = .021), intertrigo (11% vs. 0%, p = .001), folliculitis (31.7% vs. 5.8%, p < .001), seborrheic dermatitis (12.2% vs. 3.5%, p = .035) and facial erythema (7.3% vs. 0%, p = .012) were found to be statistically significantly more common in the obese group compared to the control group.

CONCLUSIONS

Obesity in children is associated with numerous cutaneous manifestations. Further study is needed to identify whether weight loss can reduce skin manifestations in obese children.

Infectious diseases associated with pediatric type 1 diabetes mellitus: A narrative review

Diabetes mellitus (DM) has been frequently associated with an impaired immune response against infectious agents, making affected patients at risk for more severe disease and sometimes causing worse outcomes. The recent COVID-19 pandemic has seriously affected patients with both diabetes, in particular those carrying comorbidities or with poor glycemic control. As regards pediatric diabetes mellitus, the availability of more accurate and technological tools for glycemic management and the improved markers of metabolic control might mitigate the negative impact of infections. Notably, good metabolic control of diabetes since its diagnosis reduces not only the risk of microangiopathic complications but also of impaired immune response to infectious diseases. Therefore, vaccinations are strongly recommended. Our paper aims to provide the most updated evidence regarding infectious diseases in type 1 pediatric DM.

Role of Insulin in Health and Disease: An Update

Insulin is a polypeptide hormone mainly secreted by β cells in the islets of Langerhans of the pancreas. The hormone potentially coordinates with glucagon to modulate blood glucose levels; insulin acts via an anabolic pathway, while glucagon performs catabolic functions. Insulin regulates glucose levels in the bloodstream and induces glucose storage in the liver, muscles, and adipose tissue, resulting in overall weight gain. The modulation of a wide range of physiological processes by insulin makes its synthesis and levels critical in the onset and progression of several chronic diseases. Although clinical and basic research has made significant progress in understanding the role of insulin in several pathophysiological processes, many aspects of these functions have yet to be elucidated. This review provides an update on insulin secretion and regulation, and its physiological roles and functions in different organs and cells, and implications to overall health. We cast light on recent advances in insulin-signaling targeted therapies, the protective effects of insulin signaling activators against disease, and recommendations and directions for future research.

HPLC-FRAP methodology and biological activities of different stem bark extracts of Cajanus cajan (L.) Millsp

Cajanus cajan. (L.) Millsp. (C. cajan) (Family: Fabaceae) also known as pigeon pea, is a famous food and cover/forage crop bearing a high amount of key amino acids (methionine, lysine and tryptophan). This study investigated into the total phenolic (TPC), flavonoid content (TFC), antioxidant [2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2 -azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), ferric reducing antioxidant power (FRAP), cupric reducing antioxidant capacity, total antioxidant capacity (TAC) (phosphomolybdenum) and metal chelating] activities and enzyme [α-amylase, α-glucosidase, tyrosinase, acetyl-(AChE), butyryl-(BChE) cholinesterase] inhibitory effects of four extracts (methanol, hexane, ethyl acetate, aqueous) prepared from C. cajan stem bark. Direct identification of antioxidants was also conducted using the high performance liquid chromatography-ferric reducing antioxidant power (HPLC-FRAP) system. The highest TPC and TFC were recorded with the methanolic (23.22 ± 0.17 mg GAE/g) and ethyl acetate extracts (19.43 ± 0.24 mg RE/g), respectively. The methanolic extract exhibited important antioxidant activity with DPPH (38.41 ± 0.05 mg Trolox equivalent (TE)/g), ABTS (70.49 ± 3.62 mg TE/g), CUPRAC (81.86 ± 2.40 mg TE/g), FRAP (42.96 ± 0.59 mg TE/g) and metal chelating (17.00 ± 1.26 mg ethylenediaminetetraacetic acid equivalent/g). p-coumaric and caffeic acid were the predominant antioxidants in the samples. Results from enzymatic assays showed the potential abilities of hexane extract in inhibiting the AChE, BChE, α-amylase and α-glucosidase enzymes. From the results obtained in this study, it can be concluded that C. cajan can be considered as a promising source of antioxidants and key enzyme inhibitors that can be exploited for future bioproduct development.

Obesity, but not overweight, is associated with plantar light touch sensation in children aged 8 to 16 years: A cross-sectional study

OBJECTIVE

Increased foot-ground contact loading engenders adaptive glabrous skin thickening and can decrease mechanoreceptor acuity and alter plantar cutaneous sensation. There has not been any research on whether overweight and obesity are similarly associated with normal plantar cutaneous sensation scores in children. This study investigated the associations between normal plantar cutaneous sensation scores and weight status (i.e., healthy weight, overweight, and obesity) in a sample of youth.

METHODS

Plantar sensation was tested among 122 participants aged 8 to 16 years (10.3 ± 1.8 years; 140.0 ± 11.2 cm; 44.2 ± 16.0 kg) across the forefoot, midfoot, and rearfoot using Semmes-Weinstein pressure aesthesiometry (0.07 g and 0.4 g monofilaments). Weight status was determined using the Centers for Disease Control and Prevention growth charts. Age- and sex-adjusted models were used to explore the relationships between normal plantar sensation scores and weight status. Significant two-tailed tests were set at p < .05.

RESULTS

Only obesity was inversely associated with normal plantar sensation scores on the left (β = -.241; p = .009) and right (β = -.222; p = .018) forefeet, left (β = -.322; p = .001) and right (β = -.253; p = .007) midfeet, and left (β = -.286; p = .002) and right (β = -.228; p = .014) wholefeet (relative to healthy weight) when using the 0.07 g monofilament. There was no association between obesity and plantar sensation when using the 0.4 g monofilament.

CONCLUSIONS

Obesity is associated with diminished light touch plantar sensation. Considering previously reported higher mechanical loading and the fact that Merkel cells and the Aβfibers that innervate them are superficial to the hypodermis, adaptive glabrous skin thickening (rather than fat pad thickness) may underlie this association. Contrary to previous suggestions, overweight is not associated with decreased plantar cutaneous sensation.

Keratosis Pilaris and its Subtypes: Associations, New Molecular and Pharmacologic Etiologies, and Therapeutic Options

Keratosis pilaris is a common skin disorder comprising less common variants and rare subtypes, including keratosis pilaris rubra, erythromelanosis follicularis faciei et colli, and the spectrum of keratosis pilaris atrophicans. Data, and critical analysis of existing data, are lacking, so the etiologies, pathogeneses, disease associations, and treatments of these clinical entities are poorly understood. The present article aims to fill this knowledge gap by reviewing literature in the PubMed, EMBASE, and CINAHL databases and providing a comprehensive, analytical summary of the clinical characteristics and pathophysiology of keratosis pilaris and its subtypes through the lens of disease associations, genetics, and pharmacologic etiologies. Histopathologic, genomic, and epidemiologic evidence points to keratosis pilaris as a primary disorder of the pilosebaceous unit as a result of inherited mutations or acquired disruptions in various biomolecular pathways. Recent data highlight aberrant Ras signaling as an important contributor to the pathophysiology of keratosis pilaris and its subtypes. We also evaluate data on treatments for keratosis pilaris and its subtypes, including topical, systemic, and energy-based therapies. The effectiveness of various types of lasers in treating keratosis pilaris and its subtypes deserves wider recognition.

Musculoskeletal Fitness Measures Are Not Created Equal: An Assessment of School Children in Corpus Christi, Texas

This study investigated current obesity prevalence and associations between musculoskeletal fitness test scores and the odds of being underweight, overweight, or obese compared to having a healthy weight in elementary school children in Corpus Christi, Texas. The sample analyzed consisted of 492 public elementary school children between kindergarten and fifth grade. Their ages ranged from 5 to 11 years. Trunk lift, 90° push-up, curl-up, and back saver sit and reach tests were administered. Weight status was determined using BMI scores and the CDC growth charts. Obesity prevalence remains high among elementary school-aged children in Corpus Christi, Texas. Higher 90° push-up test scores were most consistently associated with decreased odds of being obese as compared to being overweight and having healthy weight except in kindergarten. Conversely, higher trunk lift test scores were associated with increased odds of being obese in second and fourth grades. When children achieved the minimum score to be classified in the Healthy Fitness Zone, those with healthy weight had similarly low musculoskeletal fitness (i.e., abdominal strength and endurance, hamstring flexibility, and trunk extensor strength and flexibility) as peers with overweight and obesity, especially in the lower grades. It was concluded that increased obesity prevalence in higher grades may be precipitated (at least in part) by low musculoskeletal fitness in the lower grades, especially kindergarten. Given previous associations in the literature, low musculoskeletal fitness may be symptomatic of poor motor skill competence in the current sample. These findings suggest a need for early and focused school-based interventions that leverage both known and novel strategies to combat pediatric obesity in Corpus Christi.

Acanthosis nigricans in obese adolescents: prevalence, impact, and management challenges

Obesity in adolescence is a public health priority because it usually tracks into adulthood, resulting in enormous medical and social costs. This underscores the importance of early identification and intervention. Acanthosis nigricans (AN) was once considered a rare paraneoplastic dermatosis, but is now frequently observed in obese adolescents. Current understanding suggests that it is associated with insulin resistance and has a unique role in secondary prevention. The purpose of this narrative review is to provide a comprehensive overview of AN in obese adolescents, covering its history, current knowledge on the condition, its clinical significance, management challenges, and the direction of future research.

Hair follicle characteristics as early marker of Type 2 Diabetes

Type 2 Diabetes mellitus (DM2) includes a continuum of metabolic disorders characterized by hyperglycemia that causes several chronic long-term complications such as coronary artery disease, peripheral arterial disease, nephropathy, and neuropathy. The hair follicle could reveal signs of early vascular impairment, yet its relationship to early metabolic injuries has been largely ignored. We propose that in earlier stages of the continuum of DM2-related metabolic disorders, a group of susceptible patients who do not yet meet the diagnostic criteria to be considered as persons with DM2 may present chronic vascular impairment and end organ damage, including hair follicle damage, which can be evaluated to identify an early risk marker. This hypothesis is based in the association found between insulin resistance and alopecia in non-diabetic persons, and the hair loss on the lower limbs as a manifestation of long-term peripheral arterial disease among subjects with DM2. In order to test this hypothesis, studies are required to evaluate if hair follicle characteristics are related to and can predict hyperglycemic complications, and if they do so, which feature of the hair follicle, such as hair growth, best characterizes such DM2-related conditions. If this hypothesis were proven to be true, significant advances towards a personalized approach for early prevention strategies and management of DM2 would be made. By focusing on the hair follicles, early stages of metabolic-related organ damage could be identified using non-invasive low-cost techniques. In so doing, this approach could provide early identification of DM2-susceptible individuals and lead to the early initiation of adequate primary prevention strategies to reduce or avoid the onset of large internal organ damage.

Bariatric surgery - a dermatologic perspective

Bariatric surgery has become a standard option in morbid obesity for patients not responding to conventional treatment. A major and stable weight loss can be achieved. Since obesity and weight loss may affect skin diseases, we performed this review to analyse the impact of bariatric surgery on a number of skin diseases. We categorized the skin diseases into three main groups: (i) diseases with a possible benefit from bariatric surgery, (ii) diseases that may develop after bariatric surgery and (iii) diseases that may persist. We hope that dermatologists will achieve an updated knowledge of benefits and possible hazards of this type of surgically induced weight loss.