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Dhanoo AS, Ramroach SK, Hill-Briggs F, Cockburn BN. Grading Acanthosis Nigricans Using a Smartphone and Color Analysis: A Novel Noninvasive Method to Screen for Impaired Glucose Tolerance and Type 2 Diabetes. Diabetes Spectr 2024; 37:139-148. [PMID: 38756432 PMCID: PMC11093771 DOI: 10.2337/ds23-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Objective The objective of this study was to develop ANcam, a novel method for identifying acanthosis nigricans (AN) using a smartphone camera and computer-aided color analysis for noninvasive screening of people with impaired glucose tolerance (IGT). Research Design and Methods Adult and juvenile participants with or without diagnosed type 2 diabetes were recruited in Trinidad and Tobago. After obtaining informed consent, participants' history, demographics, anthropometrics, and A1C were collected and recorded. Three subject matter experts independently graded pictures of the posterior neck and upper back using the ANcam smartphone application and Burke methods. A correlation matrix investigated 25 color channels for association with hyperpigmentation, and the diagnostic thresholds were determined with a receiver operating characteristic curve analysis. Results For the 227 participants with captured images and A1C values, the cyan/magenta/yellow/black (CMYK) model color channel CMYK_K was best correlated with IGT at an A1C cutoff of 5.7% (39 mmol/mol) (R = 0.45, P <0.001). With high predictive accuracy (area under the curve = 0.854), the cutoff of 7.67 CMYK_K units was chosen, with a sensitivity of 81.1% and a specificity of 70.3%. ANcam had low interrater variance (F = 1.99, P = 0.137) compared with Burke grading (F = 105.71, P <0.001). ANcam detected hyperpigmentation on the neck at double the self-reported frequency. Elevated BMI was 2.9 (95% CI 1.9-4.3) times more likely, elevated blood pressure was 1.7 (95% CI 1.2-2.4) times more likely, and greater waist-to-hip ratio was 2.3 (95% CI 1.4-3.6) times more likely with AN present. Conclusion ANcam offers a sensitive, reproducible, and user-friendly IGT screening tool to any smartphone user that performs well with most skin tones and lighting conditions.
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Affiliation(s)
- Andrew S. Dhanoo
- Department of Life Sciences, University of the West Indies, St. Augustine, St. Augustine, Trinidad and Tobago
| | - Sterling K. Ramroach
- Department of Electrical and Computer Engineering, University of the West Indies, St. Augustine, St. Augustine, Trinidad and Tobago
| | | | - Brian N. Cockburn
- Department of Life Sciences, University of the West Indies, St. Augustine, St. Augustine, Trinidad and Tobago
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Triwatcharikorn J, Itthipanichpong Y, Washrawirul C, Chuenboonngarm N, Chongpison Y, Udomsawaengsup S, Boonchaya-Anant P, Rerknimitr P. Skin manifestations and biophysical changes following weight reduction induced by bariatric surgery: A 2-year prospective study. J Dermatol 2023; 50:1635-1639. [PMID: 37665164 DOI: 10.1111/1346-8138.16951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/27/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
Skin manifestations and biophysical changes are observed in patients with morbid obesity. However, reports of changes after significant weight loss, particularly through post-bariatric surgery (BaS), are limited. The aim of this 2-year prospective study was to evaluate the prevalence of skin signs and their changes in patients with morbid obesity who underwent BaS. Thirty-one patients were recruited for the study, with a mean age of 38.35 (SD 10.61) years and a male preponderance (male = 19 [61.29%], female = 12 [38.71%]). Patients were scheduled for multiple visits at months 0, 3, 6, 12, 18, and 24 post-BaS. Each subject had a thorough skin examination, biophysical measurements, and laboratory tests at each visit. Striae, acanthosis nigricans (AN), and plantar hyperkeratosis were the most common skin findings (n = 30 [96.77%], 29 [93.55%], 29 [93.55%], respectively). BaS provided improvements in many skin manifestations, namely striae, AN, acrochordons, plantar hyperkeratosis, hirsutism, lymphedema, pruritus, acne, finger pebbles, and chronic venous insufficiency with varied cumulative rates of improvements. However, acute telogen effluvium was observed in 17 (54.84%) patients. Regarding skin biophysical properties, transepidermal water loss, skin hydration, and pH did not change, while sebum production on the face significantly decreased at months 3 and 6, and elasticity decreased at months 6 and 24. In conclusion, weight reduction by BaS provided improvements in various skin signs, although telogen effluvium was a common sequelae.
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Affiliation(s)
- Jidapa Triwatcharikorn
- Division of Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Yada Itthipanichpong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Chanudda Washrawirul
- Division of Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Nunthanach Chuenboonngarm
- Division of Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Yuda Chongpison
- Center for Excellence in Biostatistics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suthep Udomsawaengsup
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Treatment of Obesity and Metabolic Disease Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Patchaya Boonchaya-Anant
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pawinee Rerknimitr
- Division of Dermatology, Department of Medicine, Faculty of Medicine, The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
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Bora L, Iftode A, Muț AM, Vlaia LL, Olteanu GE, Muntean D, Dehelean CA, Buda V, Coneac GH, Danciu C. Stability Profile and Clinical Evaluation of an Innovative Hydrogel Containing Polymeric Micelles as Drug Delivery Systems with Oregano Essential Oil against Fibroepithelial Polyps. Pharmaceuticals (Basel) 2023; 16:980. [PMID: 37513892 PMCID: PMC10386020 DOI: 10.3390/ph16070980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Skin tags, also known as fibroepithelial polyps (FPs) or acrochordons, are soft, pigmented excrescences, with a prevalence of 50-60% in the population, occurring especially in the fourth decade of life. To date, FPs have been efficiently eliminated using minimum invasive methods such as surgical removal, cauterization, laser irradiation, and cryosurgery. Over-the-counter treatments are also of interest for patients due to their non-invasive character, but their clinical efficiency has not been clearly demonstrated. This study was designed in order to evaluate the efficacy of a modern-pharmaceutical-formulation-type poloxamer-based binary hydrogel, having Origanum vulgare L. essential oil (OEO-PbH) as an active ingredient in the management of FPs. The formulation has been shown to possess good qualities in terms of stability and sterility. Non-invasive measurements revealed changes in some physiological skin parameters. An increase in transepidermal water loss (TEWL) and erythema index was noted, while skin surface water content (SWC) decreased during eight weeks of treatment. The macroscopic evaluation revealed that the FPs dried and shrunk after topical treatment with OEO-PbH. Clinically, patients presented a lowering of the number of lesions on the treated area of 20-30% after one month of treatment and around 50% after the second month. Histopathological examination suggests that topical treatment with OEO-PbH may induce histological changes in the epidermis, dermis, and fibrovascular cores of FPs, including a loss of thickness, reduced size and number of blood vessels, and low cellularity. These changes may contribute to the observed reduction in size of FPs after treatment with OEO-PbH.
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Affiliation(s)
- Larisa Bora
- Department of Pharmacognosy, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Research Center for Pharmaco-Toxicological Evaluation, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Andrada Iftode
- Research Center for Pharmaco-Toxicological Evaluation, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Department of Toxicology and Drug Industry, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Ana Maria Muț
- Department II-Pharmaceutical Technology, Formulation and Technology of Drugs Research Center, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Lavinia Lia Vlaia
- Department II-Pharmaceutical Technology, Formulation and Technology of Drugs Research Center, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Gheorghe-Emilian Olteanu
- Research Center for Pharmaco-Toxicological Evaluation, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Department of Toxicology and Drug Industry, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Delia Muntean
- Research Center for Pharmaco-Toxicological Evaluation, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Department of Microbiology, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Multidisciplinary Research Center on Antimicrobial Resistance, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Cristina Adriana Dehelean
- Research Center for Pharmaco-Toxicological Evaluation, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Department of Toxicology and Drug Industry, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Valentina Buda
- Research Center for Pharmaco-Toxicological Evaluation, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Department of Clinical Pharmacy, Communication in Pharmacy and Pharmaceutical Care, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Georgeta Hermina Coneac
- Department II-Pharmaceutical Technology, Formulation and Technology of Drugs Research Center, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Corina Danciu
- Department of Pharmacognosy, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Research Center for Pharmaco-Toxicological Evaluation, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
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Karavanaki K, Paschou SA, Tentolouris N, Karachaliou F, Soldatou A. Type 2 diabetes in children and adolescents: distinct characteristics and evidence-based management. Endocrine 2022; 78:280-295. [PMID: 36029440 DOI: 10.1007/s12020-022-03172-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 08/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Since the dramatic rise of obesity prevalence in childhood and adolescence has contributed to increased rates of type 2 diabetes (T2D) in youth, we sought to explore current evidence-based management options for pediatric T2D patients. METHODS A comprehensive literature search was performed for studies of T2D in childhood and adolescence until September 2021. RESULTS Special pathophysiological and diagnostic characteristics of T2D in this age are presented, while the main focus of the article is on management. Lifestyle interventions with healthy diet and exercise are of great importance for the treatment of T2D in children and adolescents. Metformin and insulin remain the traditional therapeutical means, while liraglutide recently gained indication for children older than 10 years both in USA and Europe. Data on the use, efficacy, safety and therapeutic considerations of other pharmacological treatments in children and adolescents with T2D are critically discussed. CONCLUSION Although many new and promising therapeutic strategies have been introduced during recent years for the management of T2D in adults, available therapeutic options for the management of pediatric T2D remain limited.
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Affiliation(s)
- Kyriaki Karavanaki
- Diabetes and Obesity Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicholas Tentolouris
- Diabetes Centre, First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laikon" General Hospital, Athens, Greece
| | - Foteini Karachaliou
- Diabetes and Endocrine Clinic, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Alexandra Soldatou
- Diabetes and Obesity Unit, 2nd Department of Pediatrics, National and Kapodistrian University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece.
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5
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Severe Quantitative Scale of Acanthosis Nigricans in Neck is Associated with Abdominal Obesity, HOMA-IR, and Hyperlipidemia in Obese Children from Mexico City: A Cross-Sectional Study. Dermatol Res Pract 2022; 2022:2906189. [PMID: 35386232 PMCID: PMC8979734 DOI: 10.1155/2022/2906189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/07/2022] [Accepted: 03/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Acanthosis nigricans (AN) is a clinical sign that commonly occurs in obesity; however, its specificity and sensitivity have been controversial. It is unknown if AN severity degree can be a useful marker for cardiometabolic disorders screening. We suggest that the stratified analysis of AN severity degree in neck by Burke’s scale could be a useful tool in the screening of cardiometabolic alterations in obese children. Objective. The aim of this study was the association of AN severity degree in neck by Burke’s scale with anthropometric, biochemical, and inflammatory parameters in obese school-age children from Mexico City. Methods. A cross-sectional study was conducted, including 95 obese school-age children stratified by AN severity degree in neck by Burke’s scale. Anthropometric and fasting biochemical measurements were determined. Variables were compared by x2 test for frequencies and one-way ANOVA with Bonferroni posttest for continuous variables. Linear regression analysis adjusted by gender, BMI, and age was performed to evaluate the association between AN severity degree and cardiometabolic alterations. Statistical significance was set at
. Results. As AN severity degree in neck by Burke’s scale increased, diastolic blood pressure (
) and triglycerides (
) significantly increased and adiponectin significantly decreased (
). Positive associations between grade 3 AN and waist circumference, HOMA-IR, triglycerides, total cholesterol, and LDL cholesterol were observed. Conclusion. Our findings could be used to identify an easier clinical tool to prevent obesity progression and its complications in pediatrics. There are no similar studies.
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6
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Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Acanthosis Nigricans: An Updated Review. Curr Pediatr Rev 2022; 19:68-82. [PMID: 36698243 DOI: 10.2174/1573396318666220429085231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Early recognition of acanthosis nigricans is important because acanthosis nigricans can be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. OBJECTIVE The purpose of this article is to familiarize pediatricians with the clinical manifestations, evaluation, diagnosis, and management of acanthosis nigricans. METHODS A search was conducted in November 2021in PubMed Clinical Queries using the key term "acanthosis nigricans". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS Acanthosis nigricans is characterized by symmetric, hyperpigmented, and velvety plaques with ill-defined borders, typically involving intertriginous areas. Obesity is the most common cause of acanthosis nigricans which is increasingly observed in obese children and adolescents and can serve as a cutaneous marker of insulin resistance. Early recognition of acanthosis nigricans is important because acanthosis nigricans can also be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. This may consist of weight reduction, discontinuation of causative drugs, treatment of underlying endocrinopathy, or treatment of an underlying malignancy. For patients with isolated acanthosis nigricans and for those whose underlying cause is not amenable to treatment, treatment of the lesion may be considered for cosmetic reasons. Topical retinoids, vitamin D analogs, chemical peels, and other keratolytics are often used for the treatment of localized lesions. Seldom, systemic therapy such as oral retinoids may be considered for extensive or generalized acanthosis nigricans and acanthosis nigricans unresponsive to topical therapy. Other uncommon treatment modalities include dermabrasion, laser therapy, and surgical removal. CONCLUSION Although acanthosis nigricans is treatable, a complete cure is difficult to achieve. The underlying cause should be treated, if possible, to resolve and prevent the recurrence of acanthosis nigricans. The diagnosis is mainly clinical, based on the characteristic appearance (symmetrically distributed, hyperpigmented, velvety, papillomatous, hyperkeratotic plaques with ill-defined borders) and the typical sites (intertriginous areas, flexural area, and skin folds) of the lesions. The diagnosis might be difficult for lesions that have atypical morphology or are in an unusual location. Clinicians should be familiar with the clinical signs, evaluation, diagnosis, and therapy of acanthosis nigricans because of the link between it and underlying diseases.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
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Rezaiian F, Davoodi SH, Nikooyeh B, Ehsani AH, Kalayi A, Shariatzadeh N, Zahedirad M, Neyestani TR. Metabolic Syndrome and Its Components are Linked with Increased Risk of Non-Melanoma Skin Cancers in Iranian Subjects: A Case-Control Study. Nutr Cancer 2021; 74:2451-2459. [PMID: 34875944 DOI: 10.1080/01635581.2021.2012581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The associations between components of metabolic syndrome (MetS), insulin resistance (IR), and several malignancies have been reported. However, the possible link between IR and dermal malignancies, including non-melanoma skin cancers (NMSCs), has not been investigated to date. In this study, we aimed to examine the possible association between components of MetS, IR, adhesion molecules, and NMSC for the first time. This was a case-control study comprising 73 confirmed cases of NMSC and 72 unrelated healthy controls. Anthropometric and biochemical assessments including fasting blood lipid profile, glucose and insulin assays were performed. To evaluate IR, HOMA-IR formula was used. Though fasting serum glucose showed no significant between-group difference, serum concentrations of insulin (p = 0.048) as well as HOMA-IR (p = 0.037) were both significantly higher in NMSC group than in controls. Logistic regression analysis revealed significant associations between waist circumference (OR: 1.04, 95% CI: 1.007-1.080, p = 0.018), percent of visceral fat (OR: 1.10, 95% CI: 1.024-1.190, p = 0.01), HOMA-IR (OR: 1.169, 95% CI: 1.004-1.360, p = 0.044), circulating VCAM-1 concentrations (OR: 1.005, 95% CI: 1.003-1.007, p < 0.001) and NMSC risk. Interestingly, the occurrence of MetS was significantly higher in subjects with NMSC than in healthy controls (p = 0.038). MetS and its components were associated with increased NMSC risk.
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Affiliation(s)
- Fatemeh Rezaiian
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition and Food Technology Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayed Hossein Davoodi
- Department of Cellular Molecular Nutrition, National Nutrition and Food Technology Research Institute and Faculty of Nutrition and Food Technology Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Nikooyeh
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition and Food Technology Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Houshang Ehsani
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Kalayi
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition and Food Technology Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nastaran Shariatzadeh
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition and Food Technology Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maliheh Zahedirad
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition and Food Technology Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tirang R Neyestani
- Laboratory of Nutrition Research, National Nutrition and Food Technology Research Institute and Faculty of Nutrition and Food Technology Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Thappa DM, Chandrashekar L, Rajappa M, Usha R, Muthupandi K, Mohanraj PS, Munisamy M, Singh N. Assessment of Patients with Periorbital Melanosis for Hyperinsulinemia and Insulin Resistance. Indian Dermatol Online J 2021; 12:244-249. [PMID: 33959520 PMCID: PMC8088194 DOI: 10.4103/idoj.idoj_491_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/02/2020] [Accepted: 10/21/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Periorbital melanosis (PM) is one of the most common dermatological condition seen in routine practice. Several cutaneous markers such as acanthosis nigricans have been associated with insulin resistance (IR). However, the association of PM with IR needs to be substantiated. Objective: The objective of the study is to evaluate the association of circulating adipokines and IR with PM. Materials and Methods: In this cross-sectional study, we recruited 100 patients with PM and 100 age- and gender-matched healthy controls. The serum levels of leptin, adiponectin, fasting glucose, fasting insulin, insulin-like growth factor-1 (IGF-1), homeostatic model assessment of insulin resistance (HOMA-IR), and leptin: adiponectin ratio (L/A ratio) were assayed. Results: The serum levels of leptin, fasting glucose, fasting insulin, HOMA-IR, L/A ratio were significantly higher in patients with PM as compared to controls. The serum levels of adiponectin were significantly lower in cases as compared to controls. On multivariate regression analysis, leptin, adiponectin, and HOMA-IR were found to be significant, even after adjusting for BMI, blood pressure and LDL and HDL cholesterol. Conclusion: Our findings suggest that patients with PM have hyperinsulinemia, IR, and elevated L/A ratio. PM as a marker of IR in adults may help in identifying patients early and thus aid in the early prevention and management of the disease.
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Affiliation(s)
- Devinder M Thappa
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Laxmisha Chandrashekar
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Medha Rajappa
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - R Usha
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - K Muthupandi
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Palani S Mohanraj
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Malathi Munisamy
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Nidhi Singh
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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9
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Pardeshi SS, Khemani UN, Kamath RR, Kura MM, Jafferany M. Therapeutic implications of dermoscopic findings in acanthosis nigricans: A clinical and histopathological study. Dermatol Ther 2020; 33:e14521. [PMID: 33176058 DOI: 10.1111/dth.14521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022]
Abstract
Acanthosis nigricans is associated with numerous systemic disorders. These include endocrinological conditions such as, diabetes, acromegaly, Cushing's syndrome, thyroid dysfunction, as well as metabolic abnormalities like obesity and polycystic ovarian disease. Its association with visceral malignancy is known. Moreover, Acanthosis nigricans is known to be a cutaneous marker of insulin resistance (IR) and hyperinsulinemia. The primary aim of this study was to study clinical and histopathological patterns of acanthosis nigricans and its correlation with dermoscopic patterns and treatment implications. 103 patients clinically diagnosed as acanthosis nigricans were enrolled in the study. Clinical evaluation, dermoscopy, and skin biopsy was done for histopathological evaluation. Consistency was observed in the changes seen on dermoscopy with clinical and histopathological findings. Common dermoscopy findings were Crista Cutis, Sulcus Cutis, Papillary projections, hyperpigmented dots, crypts, and blotching Dermoscopic findings can be correlated with histopathological features. Dermoscopy allows visualization on higher magnification which helps to pick up subtle changes which are not visible to naked eye. Dermoscopy can be a useful tool to distinguish acanthosis nigricans from other pigmentary disorders in patients who are not willing for histopathological examination and helps in treatment making decisions.
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Affiliation(s)
| | - Usha N Khemani
- Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | | | - Mahendra M Kura
- Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - Mohammad Jafferany
- Central Michigan University/CMU Medical Education Partners Saginaw, Michigan, USA
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10
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Singh SK, Agrawal NK, Vishwakarma AK. Association of Acanthosis Nigricans and Acrochordon with Insulin Resistance: A Cross-Sectional Hospital-Based Study from North India. Indian J Dermatol 2020; 65:112-117. [PMID: 32180596 PMCID: PMC7059470 DOI: 10.4103/ijd.ijd_646_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Insulin resistance (IR) is a pre-diabetic condition and has been reported in patients with acanthosis nigricans (AN) and acrochordon. AN and acrochordon are claimed to be cutaneous markers of IR. Aim The purpose of this paper was to study the association of AN and acrochordon with IR. Methods It was a cross-sectional hospital-based study. Both groups were assessed for IR by using homeostatic model assessment of insulin resistance (HOMA-IR) formula. Results A total of 70 cases and an equal number of controls were studied. IR was observed more in cases (41.4%) compared to controls (17.1%) (P < 0.01). Mean HOMA-IR value was also significantly higher in cases (4.32 ± 4.44) compared to controls (2.27 ± 0.90) (P < 0.05). Limitations Low number of cases and controls were taken in the study. Association with hyperlipidemia and metabolic syndrome was not elicited. Conclusions AN and acrochordons were found to be associated with IR.
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Affiliation(s)
- Satyendra K Singh
- Department of Dermatology and Venereology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Neeraj K Agrawal
- Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ajay K Vishwakarma
- Department of Dermatology and Venereology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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11
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Popa ML, Popa AC, Tanase C, Gheorghisan-Galateanu AA. Acanthosis nigricans: To be or not to be afraid. Oncol Lett 2019; 17:4133-4138. [PMID: 30944606 PMCID: PMC6444334 DOI: 10.3892/ol.2018.9736] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022] Open
Abstract
Acanthosis nigricans (AN), a skin disorder with high prevalence, represents a dermatological condition with esthetic implications, but otherwise mild symptoms. For any clinician, it is in fact the tip of the iceberg, leading him/her to investigate what lies beneath the surface, since AN points to a systemic problem or disease: metabolic disorder (most frequently), endocrine syndrome, medication side effects, malignancy, and genetic factors. Sometimes, it is the first observed sign of a malignancy or of diabetes mellitus, especially in patients with chronic metabolic disorder; therefore, it is not to be taken lightly. The present review summarizes the information in literature regarding the etiopathogenesis of AN. We propose a new classification that aims to better organize the different types of AN, with implications on the extent and urgency of the investigation plan, as well as various therapeutic algorithms. Therapy options are also presented, both systemic treatments that target the underlying disease, and local ones for esthetic reasons.
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Affiliation(s)
- Maria-Linda Popa
- Department of Cellular and Molecular Biology and Histology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Biochemistry-Proteomics, ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania
| | | | - Cristiana Tanase
- Department of Biochemistry-Proteomics, ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania
| | - Ancuta-Augustina Gheorghisan-Galateanu
- Department of Cellular and Molecular Biology and Histology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- ‘C.I. Parhon’ National Institute of Endocrinology, 001863 Bucharest, Romania
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12
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Putra IB, Siregar R, Jusuf NK, Ginting O, Nurhayati R. Correlation between Serum Leptin Level with Type and Number of Lesion Skin Tag. Open Access Maced J Med Sci 2019; 7:53-55. [PMID: 30740160 PMCID: PMC6352473 DOI: 10.3889/oamjms.2019.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Skin tag is a benign tumour of connective tissue in the skin, sessile or pedunculated, skin-like to brownish coloured and often arises in the flexure area. Etiopathogenesis of skin tag is still unclear, but one of the aetiology is associated with leptin hormone. AIM To determine the correlation between leptin serum level with type and number of the lesion skin tag. METHODS This study is an observational analytic study with a cross-sectional design involving 33 skin tag patients. Diagnosis of skin tag was based on history and clinical examination; we conducted blood sampling and measurement of serum leptin level to the patients. RESULTS We found the mean serum leptin level of skin tag patients were highest on the type of lesion mixed (31.54 ± 12.85 ng/ml). The mean number of skin tag lesions was 13.6 ± 5.8 lesions. There is a very high positive correlation between serum leptin level with a number of skin tag (r = 0.86) with p < 0.05 and significant correlation between serum leptin level with the type of lesions (p = 0.037). CONCLUSION Serum leptin level has a very high positive correlation to a number of skin tag and significant correlation between serum leptin level with the type of lesion.
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Affiliation(s)
- Imam Budi Putra
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sumatera Utara, General Hospital of Universitas Sumatera Utara, Medan, Indonesia
| | - Remenda Siregar
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sumatera Utara, General Hospital of Universitas Sumatera Utara, Medan, Indonesia
| | - Nelva K Jusuf
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sumatera Utara, General Hospital of Universitas Sumatera Utara, Medan, Indonesia
| | - Oratna Ginting
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sumatera Utara, General Hospital of Universitas Sumatera Utara, Medan, Indonesia
| | - Raja Nurhayati
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sumatera Utara, General Hospital of Universitas Sumatera Utara, Medan, Indonesia
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13
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Patel NU, Roach C, Alinia H, Huang WW, Feldman SR. Current treatment options for acanthosis nigricans. Clin Cosmet Investig Dermatol 2018; 11:407-413. [PMID: 30122971 PMCID: PMC6086114 DOI: 10.2147/ccid.s137527] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Acanthosis nigricans (AN) is a common dermatologic manifestation of systemic disease that is associated with insulin resistance, diabetes mellitus, obesity, internal malignancy, endocrine disorders, and drug reactions. Treatment of AN primarily focuses on resolution of the underlying disease processes causing the velvety, hyperpigmented, hyperkeratotic plaques found on the skin. While the goal of therapy is to treat the primary cause, cosmetic resolution of AN lesions can be important for patients and their quality of life. Treatment options for AN have not been extensively studied; however, smaller powered clinical trials and case reports exist in the literature. Our review aims to explore and evaluate the current treatment options that exist for AN.
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Affiliation(s)
- Nupur U Patel
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC,
| | - Catherine Roach
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC,
| | - Hossein Alinia
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC,
| | - William W Huang
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC,
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, .,Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC.,Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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14
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Comparative study using fractional carbon dioxide laser versus glycolic acid peel in treatment of pseudo-acanthosis nigricans. Lasers Med Sci 2018; 33:1485-1491. [DOI: 10.1007/s10103-018-2505-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 04/05/2018] [Indexed: 11/25/2022]
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15
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Zhang Y, Zhu C, Wen X, Wang X, Li L, Rampersad S, Lu L, Zhou D, Qian C, Cui R, Zhang M, Yang P, Qu S, Bu L. Laparoscopic sleeve gastrectomy improves body composition and alleviates insulin resistance in obesity related acanthosis nigricans. Lipids Health Dis 2017; 16:209. [PMID: 29115953 PMCID: PMC5678791 DOI: 10.1186/s12944-017-0598-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 10/24/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Acanthosis nigricans (AN) has a close relationship with obesity. It is believed that obesity and AN have the common pathophysiological basis such as hyperinsulinism. This study is aimed to observe the effect of laparoscopic sleeve gastrectomy (LSG) on body composition and insulin resistance in Chinese obese patients with acanthosis nigricans. METHODS A total of 37 obese patients who underwent LSG in our hospital were selected for analysis. They were divided into simple obesity (OB n = 14) and obesity with acanthosis nigricans (AN n = 23) group respectively. Body composition was measured by dual-energy X-ray absorptiometry (DEXA). Anthropometric measurements and glucolipid metabolism before and 3 months post LSG were collected for analysis. RESULTS Patients with AN got noticeable improvement in skin condition and their AN score was significantly decreased (3.52 ± 0.79 vs. 1.48 ± 0.73, P < 0.001).Alleviated insulin resistance and more trunk fat loss than limbs' were observed in both groups (P value < 0.01). In AN group, preoperative android fat mass (FM) was positively correlated with fasting insulin and natural logarithm of HOMA-IR (LNIR) (r = 0.622, 0.608, respectively; all P < 0.01). Besides, changes in android FM and visceral adipose tissue (VAT) also showed significantly positive correlation with changes in LNIR (r = 0.588, r = 0.598, respectively; all P < 0.01). CONCLUSIONS LSG had a positive impact on body composition and skin condition in Chinese obese patients with AN. Loss of android FM and VAT might result in the alleviation of insulin resistance in AN patients. Android fat distribution seems to be a potential indicator of postoperative metabolic benefits for obese patients with AN.
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Affiliation(s)
- Yi Zhang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Middle Yan-chang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China
| | - Cuiling Zhu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Middle Yan-chang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China
| | - Xin Wen
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Middle Yan-chang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China
| | - Xingchun Wang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Middle Yan-chang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China
| | - Liang Li
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Middle Yan-chang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China
| | - Sharvan Rampersad
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Middle Yan-chang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China
| | - Liesheng Lu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Donglei Zhou
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, 200072, China
| | - Chunhua Qian
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Middle Yan-chang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China
| | - Ran Cui
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Middle Yan-chang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China
| | - Manna Zhang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Middle Yan-chang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China
| | - Peng Yang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Middle Yan-chang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China
| | - Shen Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Middle Yan-chang Road, Shanghai, 200072, China.,National Metabolic Management Center, Shanghai, 200072, China
| | - Le Bu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, 301 Middle Yan-chang Road, Shanghai, 200072, China. .,National Metabolic Management Center, Shanghai, 200072, China.
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16
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Baykal C. Acrochordons on the neck; a remarkable clinical feature of tuberous sclerosis showing different patterns. J Eur Acad Dermatol Venereol 2017; 32:e146-e147. [PMID: 29024216 DOI: 10.1111/jdv.14636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Baykal
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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17
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Mendes AL, Miot HA, Haddad V. Diabetes mellitus and the skin. An Bras Dermatol 2017; 92:8-20. [PMID: 28225950 PMCID: PMC5312172 DOI: 10.1590/abd1806-4841.20175514] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/29/2016] [Indexed: 11/22/2022] Open
Abstract
Several dermatoses are routinely associated with diabetes mellitus, especially in patients with chronic disease. This relationship can be easily proven in some skin disorders, but it is not so clear in others. Dermatoses such necrobiosis lipoidica, granuloma annulare, acanthosis nigricans and others are discussed in this text, with an emphasis on proven link with the diabetes or not, disease identification and treatment strategy used to control those dermatoses and diabetes.
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Affiliation(s)
- Adriana Lucia Mendes
- Department of Clinical Medicine - Faculdade de Medicina de Botucatu - Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) - Botucatu (SP), Brazil
| | - Helio Amante Miot
- Department of Dermatology and Radiotherapy - Faculdade de Medicina de Botucatu - Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) -Botucatu (SP), Brazil
| | - Vidal Haddad
- Department of Dermatology and Radiotherapy - Faculdade de Medicina de Botucatu - Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) -Botucatu (SP), Brazil
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18
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Jusuf NK, Putra IB, Kartayana J. The Correlation between Body Mass Index with the Occurrence of Skin Tag. Open Access Maced J Med Sci 2017; 5:271-274. [PMID: 28698740 PMCID: PMC5503720 DOI: 10.3889/oamjms.2017.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/24/2017] [Accepted: 04/21/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Skin tag is a benign tumour of the skin with a soft consistency which commonly occurs in the flexure area. Skin tag often found in individuals with middle and old age. Until now, there are many of theories have been proposed to explain the mechanism of the skin tag, one of the theory is obesity. AIM: To determine the body mass index (BMI) in patients with skin tag. METHODS: This study is an analytic study with cross-sectional designs involving 32 subjects with skin tag and 32 controls. Diagnosis of skin tag was made based on anamnesis and clinical examination. All subjects underwent a physical examination (height and weight) to determine BMI (weight in kilogrammes divided by the square of height in meters). To analyse association between higher BMI with the occurrence of skin tag we use student t-test. RESULTS: The mean BMI in the skin tag group (28.1+ 3.9 kg/m^2) was higher compared with the control group (24.1 + 2.3 kg/m^2). Statistical analysis by Student t-test found the p-value < 0.05. CONCLUSION: We found a correlation between increased BMI with the occurrence of the skin tag.
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Affiliation(s)
- Nelva K Jusuf
- Department Dermatovenereology, Faculty of Medicine, University of Sumatera Utara, Medan 20155, Indonesia
| | - Imam B Putra
- Department Dermatovenereology, Faculty of Medicine, University of Sumatera Utara, Medan 20155, Indonesia
| | - Johan Kartayana
- Department Dermatovenereology, Faculty of Medicine, University of Sumatera Utara, Medan 20155, Indonesia
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19
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Abstract
Metformin though primarily an antidiabetic drug, has found to play an important role in a number of cutaneous disorders. Because of its role in improving hyperinsulinemia, it has proven beneficial in hormonal acne, hidradenitis suppurativa (HS) and acanthosis nigricans. Its antiandrogenic properties further serve as an add-on to the conventional management of hirsutism associated with polycystic ovarian syndrome. Very recently, systemic usage of metformin for psoriasis and cutaneous malignancies has shown promising results. Interestingly, metformin has also been topically used in hyperpigmentary disorders with pertinent levels of improvement and happens to be the most recent addition to the list of dermatologic indications. Though an oral hypoglycemic agent to begin with, metformin today has proven to be a boon for dermatologists.
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Affiliation(s)
- Aditya Kumar Bubna
- Assistant Professor, Department of Dermatology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
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20
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Skin Manifestations of Insulin Resistance: From a Biochemical Stance to a Clinical Diagnosis and Management. Dermatol Ther (Heidelb) 2016; 7:37-51. [PMID: 27921251 PMCID: PMC5336429 DOI: 10.1007/s13555-016-0160-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Indexed: 12/18/2022] Open
Abstract
Worldwide, more than 1.9 billion adults are overweight, and around 600 million people suffer from obesity. Similarly, ~382 million individuals live with diabetes, and 40–50% of the global population is labeled at “high risk” (i.e., prediabetes). The impact of these two chronic conditions relies not only on the burden of illnesses per se (i.e., associated increased morbidity and mortality), but also on their increased cost, burden of treatment, and decreased health-related quality of life. For this review a comprehensive search in several databases including PubMed (MEDLINE), Ovid EMBASE, Web of Science, and Scopus was conducted. In both diabetes and obesity, genetic, epigenetic, and environmental factors overlap and are inclusive rather than exclusive. De facto, 70–80% of the patients with obesity and virtually every patient with type 2 diabetes have insulin resistance. Insulin resistance is a well-known pathophysiologic factor in the development of type 2 diabetes, characteristically appearing years before its diagnosis. The gold standard for insulin resistance diagnosis (the euglycemic insulin clamp) is a complex, invasive, costly, and hence unfeasible test to implement in clinical practice. Likewise, laboratory measures and derived indexes [e.g., homeostasis model assessment of insulin resistance (HOMA-IR-)] are indirect, imprecise, and not highly accurate and reproducible tests. However, skin manifestations of insulin resistance (e.g., acrochordons, acanthosis nigricans, androgenetic alopecia, acne, hirsutism) offer a reliable, straightforward, and real-time way to detect insulin resistance. The objective of this review is to aid clinicians in recognizing skin manifestations of insulin resistance. Diagnosing these skin manifestations accurately may cascade positively in the patient’s health by triggering an adequate metabolic evaluation, a timely treatment or referral with the ultimate objective of decreasing diabetes and obesity burden, and improving the health and the quality of care for these patients.
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21
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Kunche S, Yan H, Calof AL, Lowengrub JS, Lander AD. Feedback, Lineages and Self-Organizing Morphogenesis. PLoS Comput Biol 2016; 12:e1004814. [PMID: 26989903 PMCID: PMC4798729 DOI: 10.1371/journal.pcbi.1004814] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/15/2016] [Indexed: 01/31/2023] Open
Abstract
Feedback regulation of cell lineage progression plays an important role in tissue size homeostasis, but whether such feedback also plays an important role in tissue morphogenesis has yet to be explored. Here we use mathematical modeling to show that a particular feedback architecture in which both positive and negative diffusible signals act on stem and/or progenitor cells leads to the appearance of bistable or bi-modal growth behaviors, ultrasensitivity to external growth cues, local growth-driven budding, self-sustaining elongation, and the triggering of self-organization in the form of lamellar fingers. Such behaviors arise not through regulation of cell cycle speeds, but through the control of stem or progenitor self-renewal. Even though the spatial patterns that arise in this setting are the result of interactions between diffusible factors with antagonistic effects, morphogenesis is not the consequence of Turing-type instabilities.
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Affiliation(s)
- Sameeran Kunche
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, United States of America
- Center for Complex Biological Systems, University of California, Irvine, Irvine, California, United States of America
| | - Huaming Yan
- Center for Complex Biological Systems, University of California, Irvine, Irvine, California, United States of America
- Department of Mathematics, University of California, Irvine, Irvine, California, United States of America
| | - Anne L. Calof
- Center for Complex Biological Systems, University of California, Irvine, Irvine, California, United States of America
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, California, United States of America
- Department of Anatomy and Neurobiology, University of California, Irvine, Irvine, California, United States of America
- * E-mail: (ALC); (JSL); (ADL)
| | - John S. Lowengrub
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, United States of America
- Center for Complex Biological Systems, University of California, Irvine, Irvine, California, United States of America
- Department of Mathematics, University of California, Irvine, Irvine, California, United States of America
- * E-mail: (ALC); (JSL); (ADL)
| | - Arthur D. Lander
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, United States of America
- Center for Complex Biological Systems, University of California, Irvine, Irvine, California, United States of America
- Department of Developmental and Cell Biology, University of California, Irvine, Irvine, California, United States of America
- * E-mail: (ALC); (JSL); (ADL)
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22
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Diabetes mellitus: Possible risk and promoting factors of cholangiocarcinoma. Cancer Epidemiol 2015; 39:274-8. [PMID: 25910864 DOI: 10.1016/j.canep.2015.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/26/2015] [Accepted: 04/05/2015] [Indexed: 12/17/2022]
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23
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Kutlubay Z, Engin B, Bairamov O, Tüzün Y. Acanthosis nigricans: A fold (intertriginous) dermatosis. Clin Dermatol 2015; 33:466-70. [PMID: 26051063 DOI: 10.1016/j.clindermatol.2015.04.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acanthosis nigricans (AN) is a mucocutaneous disorder that is characterized by focal or diffuse hyperkeratotic, surfaces, which are symmetrically distributed hyperpigmented lesions of the skin. It rarely affects mucosal surfaces like oral cavities. Although it is commonly seen in adolescents, AN is also increasingly seen in children who are obese. Recent studies have found that AN can be a cutaneous indicator of insulin resistance and malignancy. Acanthosis nigricans has been associated with type 2 diabetes mellitus, obesity, endocrinopathies, drugs, and malignancies.
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Affiliation(s)
- Zekayi Kutlubay
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University, Fatih, Istanbul 34098, Turkey.
| | - Burhan Engin
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University, Fatih, Istanbul 34098, Turkey
| | - Orkhan Bairamov
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University, Fatih, Istanbul 34098, Turkey
| | - Yalçın Tüzün
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University, Fatih, Istanbul 34098, Turkey
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24
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Ibarra-Reynoso LDR, Pisarchyk L, Pérez-Luque EL, Garay-Sevilla ME, Malacara JM. Whole-body and hepatic insulin resistance in obese children. PLoS One 2014; 9:e113576. [PMID: 25411786 PMCID: PMC4239088 DOI: 10.1371/journal.pone.0113576] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 10/25/2014] [Indexed: 12/11/2022] Open
Abstract
Background Insulin resistance may be assessed as whole body or hepatic. Objective To study factors associated with both types of insulin resistance. Methods Cross-sectional study of 182 obese children. Somatometric measurements were registered, and the following three adiposity indexes were compared: BMI, waist-to-height ratio and visceral adiposity. Whole-body insulin resistance was evaluated using HOMA-IR, with 2.5 as the cut-off point. Hepatic insulin resistance was considered for IGFBP-1 level quartiles 1 to 3 (<6.67 ng/ml). We determined metabolite and hormone levels and performed a liver ultrasound. Results The majority, 73.1%, of obese children had whole-body insulin resistance and hepatic insulin resistance, while 7% did not have either type. HOMA-IR was negatively associated with IGFBP-1 and positively associated with BMI, triglycerides, leptin and mother's BMI. Girls had increased HOMA-IR. IGFBP-1 was negatively associated with waist-to-height ratio, age, leptin, HOMA-IR and IGF-I. We did not find HOMA-IR or IGFBP-1 associated with fatty liver. Conclusion In school-aged children, BMI is the best metric to predict whole-body insulin resistance, and waist-to-height ratio is the best predictor of hepatic insulin resistance, indicating that central obesity is important for hepatic insulin resistance. The reciprocal negative association of IGFBP-1 and HOMA-IR may represent a strong interaction of the physiological processes of both whole-body and hepatic insulin resistance.
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Affiliation(s)
| | - Liudmila Pisarchyk
- Department of Medical Sciences, University of Guanajuato, Campus León, 20 de Enero 929, León Guanajuato, México
| | - Elva Leticia Pérez-Luque
- Department of Medical Sciences, University of Guanajuato, Campus León, 20 de Enero 929, León Guanajuato, México
| | - Ma. Eugenia Garay-Sevilla
- Department of Medical Sciences, University of Guanajuato, Campus León, 20 de Enero 929, León Guanajuato, México
- * E-mail:
| | - Juan Manuel Malacara
- Department of Medical Sciences, University of Guanajuato, Campus León, 20 de Enero 929, León Guanajuato, México
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Cestari TF, Dantas LP, Boza JC. Acquired hyperpigmentations. An Bras Dermatol 2014; 89:11-25. [PMID: 24626644 PMCID: PMC3938350 DOI: 10.1590/abd1806-4841.20142353] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 03/25/2013] [Indexed: 01/15/2023] Open
Abstract
Cutaneous hyperpigmentations are frequent complaints, motivating around 8.5% of all
dermatological consultations in our country. They can be congenital, with different
patterns of inheritance, or acquired in consequence of skin problems, systemic
diseases or secondary to environmental factors. The vast majority of them are linked
to alterations on the pigment melanin, induced by different mechanisms. This review
will focus on the major acquired hyperpigmentations associated with increased
melanin, reviewing their mechanisms of action and possible preventive measures.
Particularly prominent aspects of diagnosis and therapy will be emphasized, with
focus on melasma, post-inflammatory hyperpigmentation, periorbital pigmentation,
dermatosis papulosa nigra, phytophotodermatoses, flagellate dermatosis, erythema
dyschromicum perstans, cervical poikiloderma (Poikiloderma of Civatte), acanthosis
nigricans, cutaneous amyloidosis and reticulated confluent dermatitis
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Affiliation(s)
- Tania Ferreira Cestari
- Rio Grande do Sul Federal University, Internal Medicine Department, Porto Alegre(RS), Brazil, PhD - Associate Professor at the Internal Medicine Department, at Rio Grande do Sul Federal University (UFRGS). Teaching Professor at the Child and Adolescent Health Sciences and the Surgical Post-Graduation Programs at Rio Grande do Sul Federal University (UFRGS). Chief of the Dermatology Department at Porto Alegre Clinics Hospital - Rio Grande do Sul Federal University (HCPA-UFRGS) - Porto Alegre (RS), Brazil
| | - Lia Pinheiro Dantas
- Rio Grande do Sul Federal University, Medical Sciences Post Graduation program, Porto AlegreRS, Brazil, MD, Dermatologist, MSc (in course) at the Medical Sciences Post Graduation program at Rio Grande do Sul Federal University (UFRGS) - Porto Alegre (RS), Brazil
| | - Juliana Catucci Boza
- Rio Grande do Sul Federal University, Child and Adolescent Health Sciences Post Graduation Program, Porto AlegreRS, Brazil, MD, Dermatologist, PhD (in course) at the Child and Adolescent Health Sciences Post Graduation Program at Rio Grande do Sul Federal University (UFRGS) - Porto Alegre (RS), Brazil
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Abstract
Acanthosis nigricans (AN) is characterized by dark, coarse and thickened skin with a velvety texture, being symmetrically distributed on the neck, the axillae, antecubital and popliteal fossae, and groin folds, histopathologically characterized by papillomatosis and hyperkeratosis of the skin. A high prevalence of AN has been observed recently. Different varieties of AN include benign, obesity associated, syndromic, malignant, acral, unilateral, medication-induced and mixed AN. Diagnosis is largely clinical with histopathology needed only for confirmation. Other investigations needed are fasting lipoprotein profile, fasting glucose, fasting insulin, hemoglobin and alanine aminotransferase for obesity associated AN and radiological investigations (plain radiography, ultrasonography, magnetic resonance imaging/computerized tomography) for malignancy associated AN. The most common treatment modalities include retinoids and metformin.
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Affiliation(s)
- Meghana Madhukar Phiske
- Assistant Professor, Department of Dermatology, L.T.M.M.C and General Hospital, Sion, Mumbai, Maharashtra, India
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Schilling WHK, Crook MA. Cutaneous stigmata associated with insulin resistance and increased cardiovascular risk. Int J Dermatol 2014; 53:1062-9. [PMID: 24697530 DOI: 10.1111/ijd.12463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Certain cutaneous conditions have been reported to be associated with diabetes mellitus, insulin resistance, and metabolic syndrome. In this novel review paper, the evidence linking various cutaneous phenomena (e.g. skin tags, acanthosis nigricans, ear lobe creases, and xanthelasma) and metabolic syndrome and cardiovascular disease is examined, and explanations for these associations are proposed.
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Affiliation(s)
- William H K Schilling
- Clinical Biochemistry and Metabolic Medicine, University Hospital Lewisham and Guy's and St Thomas' Hospital, London, UK
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Stears A, Hames C. Diagnosis and management of lipodystrophy: a practical update. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/clp.14.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ehling D. Integrative techniques using acupuncture, Chinese herbal medicine, diet, and supplements for polycystic ovary syndrome: a case report. JOURNAL OF INTEGRATIVE MEDICINE 2013; 11:422-427. [PMID: 24299606 DOI: 10.3736/jintegrmed2013055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Dagmar Ehling
- Oriental Health Solutions, LLC., Durham, North Carolina 27705, USA
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Gambineri A, Fanelli F, Prontera O, Repaci A, Di Dalmazi G, Zanotti L, Pagotto U, Flacco ME, Guidi J, Fava GA, Manzoli L, Pasquali R. Prevalence of hyperandrogenic states in late adolescent and young women: epidemiological survey on italian high-school students. J Clin Endocrinol Metab 2013; 98:1641-50. [PMID: 23436925 DOI: 10.1210/jc.2012-3537] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Most of the estimates of the prevalence of hyperandrogenic states refer to the general adult population. OBJECTIVE The objective of the study was to estimate the prevalence of hyperandrogenic states in late adolescence and youth and to evaluate potential independent predictors. DESIGN This was a cross-sectional study. SETTING The study was conducted in high schools. PATIENTS Patients included female students, aged 16-19 years. MAIN OUTCOME MEASURES The study protocol was designed with 3 possible levels of participation: the first level consisted of a self-compiled questionnaire; the second level added a medical examination; and the third level added a blood sample for laboratory testing. Liquid chromatography-tandem mass spectrometry was used to measure total testosterone, and a reference interval was established in-house. RESULTS We offered participation to 2052 students, and 1469 of those compiled the questionnaire. Of these, 1038 were examined, and 519 also provided blood samples. Two hundred three of the 1038 examined students and 125 of the 519 students who provided blood samples were subsequently excluded because of treatment with oral contraceptives or because of endocrine disorders. In the sample of women with a questionnaire + a medical examination, 13% were affected by isolated menstrual irregularity, 16.1% by isolated clinical hyperandrogenism, and 3.8% by both states. A similar prevalence of isolated menstrual irregularity (10.2%) and isolated clinical hyperandrogenism (16.7%) was found in the subsample of women with laboratory tests; in addition, 6.6% showed isolated hyperandrogenemia, and 4.3% proved to be affected by polycystic ovary syndrome. CONCLUSIONS This study provides for the first time a reliable assessment of the prevalence of hyperandrogenic states in late adolescent and young females and confirms that hyperandrogenic disorders originate at a young age.
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Affiliation(s)
- Alessandra Gambineri
- Endocrinology Unit, Department of Clinical Medicine, St Orsola-Malpighi Hospital, Bologna, Italy
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