The relationship between acrochordons, obesity, and metabolic syndrome in the pediatric population: A retrospective cohort study

BACKGROUND

Acrochordons or skin tags are common benign skin growths. Several studies explored the relationship between obesity and metabolic syndrome in adults but remains unexplored in children.

METHODS

This was a single-center retrospective cohort study of outpatient dermatology patients between 1 January 2000 to 1 January 2021. Children under 18 years old diagnosed with acrochordons using diagnostic codes International Classification of Diseases, 10th Revision (ICD-10) L91.8 and 9th Revision (ICD-9) 701.8 were included. We collected patient demographics, past medical history, laboratory values, vital signs, and physical exam. Body mass index (BMI) was calculated and stratified into categories based on the Center for Disease Control's BMI-for-Age Growth Charts. Metabolic syndrome was diagnosed when three of the five criteria were met. Data were propensity-matched and compared with NHANES (National Health and Nutrition Examination Survey), which offered a generalizable sample to the US population.

RESULTS

Fifty-five patients under 18 years old with a diagnosis of acrochordons were mostly Caucasian (76%) and female (64%). The mean BMI was 27.3, with 49.5% categorized as obese and 20% as overweight. The mean age of diagnosis was 10.1 years. Acrochordon predominantly appeared in the axilla. In our cohort, three patients (5.5%) met the criteria for metabolic syndrome. The prevalence of obesity (42% vs. 21%), type 2 diabetes mellitus (4.8% vs. 0.6%), hyperlipidemia (8.1% vs. 0%), and hypertension (1.6% vs. 0%) was greater in our cohort compared with NHANES.

CONCLUSIONS

Like the adult population, acrochordons may serve as marker for metabolic disease in the pediatric population.

Mycosis Fungoides Exhibits the Features of Skin Tags: A Case Report

We present the case of a 37-year-old male diagnosed with Mycosis fungoides (MF) after gradually developing multiple skin tags and brownish lichenoid papules. The patient had pre-existing erythema over his entire body, especially his face, upper extremities, and trunk, for over 1.5 years. Microscopic examination of the papule and the skin tag (ST) exhibited similar features mainly characterized by superficial dense band-like lymphoid infiltrates and epidermotropism of atypical lymphocytes (Pautrier's micro-abscesses). Immunohistochemistry further revealed the lymphoid infiltrates predominantly expressed LCA, CD3, CD4, and CD45RO but lacked CD7, CD8, CD30, CD20, and CD79a. The finding of this study that reports MF characterized by unusual STs suggests that some causes and effects have not been previously described in MF.

Acanthosis Nigricans Presenting as Skin Tags: A Case Report

Acanthosis nigricans (AN) is a common chronic disorder that is characterized by velvety-like, hyperpigmented, hyperkeratotic plaques, typically in intertriginous areas. However, atypical presentations have been reported. Here we present a five-year-old boy presented with a one-year history of asymptomatic slowly progressing skin lesions. He is a known case of type 1 diabetes mellites on insulin treatment, otherwise healthy. The review of systems was unremarkable. No similar case was found in the family. Skin examination revealed multiple tiny non-scaly brownish papules on the medial aspects of the upper thighs, bilaterally. Differential diagnosis included skin tags, viral warts, and dermatosis papulose nigra (DPN). Dermoscopic findings revealed a velvety-like appearance on the papules and the normal skin surrounding the papules. A 2-mm punch skin biopsy of the papule revealed papillomatosis of the epidermis, and the granular layer was normal. The dermis was normal. On the basis of the above clinicopathological findings, specifically the velvety texture of the normal skin surrounding the papules, the patient was diagnosed with ANs. The parent was reassured, and we started the patient on daily tretinoin cream.

Role of insulin-like growth factor-1 in skin tags: a clinical, genetic and immunohistochemical study in a sample of Egyptian patients

Background: Skin tags (STs) are benign connective tissue neoplasms, in which insulin-like growth factor −1 (IGF-1) has a mitogenic and antiapoptotic activity.

Purpose: We aimed to study for the first time, the possible role of IGF-1 (CA) 19 and rs6214 gene polymorphisms, and its tissue immunoreactivity in the pathogenesis of STs.

Patients and methods: This case–control study included 40 ST patients and 20 controls. We searched for (CA) 19 single-nucleotide polymorphism (SNP) using conversional PCR and for rs6214 gene polymorphism using real-time PCR. IGF-1 tissue immunoreactivity was investigated using polyclonal IGF-1 antibody.

Results: IGF-1 immunoreactivity showed significantly strong upregulation in epidermis (p=0.002) and dermal components (endothelial cells [p=0.038] and fibroblasts [p=0.004]) of excised STs than control skin. TT and CT rs6214 genotypes and its T allele were significantly associated with STs (p=0.006 and P=0.002, respectively). Also (<192 bp) and 192–194 bp (CA) 19 genotypes were significantly predominant in ST patients than controls (p=0.013). These 4 genotypes were significantly associated with development of multiple STs and epidermal IGF-1 tissue immunoreactivity in studied patients.

Conclusions: IGF-1 (CA) 19 and rs6214 gene polymorphisms may contribute to a predisposition of STs in Egyptian patients, the role of which could be mediated through local upregulation of IGF-1 in cutaneous tissues.

Role of 11β HSD 1, rs12086634, and rs846910 single-nucleotide polymorphisms in metabolic-related skin diseases: a clinical, biochemical, and genetic study

Background

11β HSD1 generates cortisol from cortisone. 11β HSD1 single-nucleotide polymorphism (SNP) was associated with metabolic syndrome (MeTS). Although the relation of acne vulgaris (AV) and skin tags (STs) with MeTS has been reported, the relationship between 11β HSD 1 SNP and cortisol activity in those patients has not studied till now.

Aims

To investigate, two 11β-HSD1 SNPs (rs846910 and rs12086634), serum lipid profile and cortisol levels in patients with AV and STs in an Egyptian population.

Patients and methods

This case–control study was performed on 50 patients having STs and 50 complaining of AV and 50 sex- and age-matched controls. We searched for serum lipid profile, cortisol levels, and 11β-HSD1 rs846910 and rs12086634 SNPs using real time-PCR.

Results

Compared to controls,11β-HSD1 rs846910 GA genotype carriers had significantly higher risks for developing AV and STs by 3.4- and 4.9-fold, respectively, and its A allele increases these risks by 3.1 and 4.4 times, respectively. Also, 11β-HSD1 rs12086634 TG genotype increases the risk of AV by 3.2-fold, as well as STs by 3.5-fold, and its G allele increases the risk of AV by 3.2-fold and STs by 7-fold. In AV and ST patients, rs846910 GA genotype demonstrated significant associations with elevated body mass index (BMI), and cholesterol, low density lipoprotein (LDL), cortisol, and decreased high density lipoprotein serum levels, respectively. However, rs12086634 GG genotype was significantly associated with increased BMI, cholesterol, and LDL serum levels in patients with AV and STs, in addition to the number of STs and serum cortisol levels in ST patients.

Conclusion

11β-HSD1 rs846910 and rs12086634 gene polymorphisms may contribute to AV and STs pathogenesis, that may be mediated through enhancing the enzymatic activity (increasing cortisol levels). AV and STs are associated with obesity and atherogenic lipid profile. Diagnosis of AV and STs may play a role in early detection of the MeTS.

Association of Skin Tag with Metabolic Syndrome and its Components: A Case-control Study from Eastern India

Background:

Skin tags are benign polyps, usually found in the natural folds of the skin. Some studies have found an association of skin tags with obesity, diabetes, hypertension, and atherogenic lipid profile. Metabolic syndrome refers to co-occurrence of these cardiovascular risk factors such as insulin resistance, obesity, dyslipidemia, and hypertension.

Aims and Objectives:

To find out any possible association of skin tags with metabolic syndrome and its components.

Materials and Methods:

A case–control study was conducted including 140 participants. Seventy patients with skin tags were considered cases, and 70 age- and sex-matched patients without skin tags were considered as controls. Various anthropometric and biochemical parameters were compared and analyzed between the two groups.

Results:

Univariate analysis revealed significantly higher waist circumference, high triglyceride, and low high-density lipoproteins (HDLs) in cases compared to controls. The prevalence of diabetes, hypertension, and metabolic syndrome was significantly higher in patients with skin tags, and risk of developing metabolic syndrome was 11.13 times higher in cases compared to controls (P < 0.05). Multivariate logistic regression analysis revealed high waist circumference and low serum HDL had significant association with skin tags.

Conclusion:

Risk of development of metabolic syndrome is significantly higher in patients with skin tags. Among the various components of metabolic syndrome, only high waist circumference and low serum HDLs are significantly associated with skin tags.

Delleman-Oorthuys syndrome (oculocerebrocutaneous syndrome) in a Nigerian child: a case report

Background:

Delleman–Oorthuys syndrome, also known as oculocerebrocutaneous syndrome, is a rare congenital anomaly with ocular, cerebral and cutaneous manifestations. So far, only 40 cases have been described.

Clinical case:

A 3-year-old female Nigerian child with no identifiable left eyeball, multiple left-sided facial skin defects and delayed developmental milestones but otherwise uneventful medical and family history was evaluated at the Ophthalmology and Paediatric Neurosurgery in Ibadan, Nigeria. Besides the mentioned defects that were present since birth, brain imaging revealed several brain abnormalities including intracranial cysts. Global hyperreflexia and bilateral flexor plantar response were observed upon clinical examination. Left micro-ophthalmia and orbital mass were detected. A histological assessment of the orbital mass revealed it to be rudimentary ocular tissue. The diagnosis of Delleman–Oorthuys syndrome was made based on the clinico-radiological features. The patient underwent a left-sided posterior fossa cystoperitoneal shunt. The left orbital mass was enuclated and the patient is currently awaiting left eyelid reconstruction and an orbital implant and repair of the left alar nasi cleft.

Conclusion:

To our knowledge, this is the first published report of Delleman–Oorthuys syndrome in a female child of West African descent. Given the variable manifestations of Delleman–Oorthuys syndrome, and overlap with other syndromes, the Delleman–Oorthuys syndrome may be underreported. Neuroimaging of patients with cutaneous tags, orbital cysts and micro-ophthalmia could reveal more cases.

The Association of Various Metabolic Parameters with Multiple Skin Tags

Background: Skin tags (STs) are benign skin lesions. Their definite etiology remains unknown. We aim to examine the association of obesity, diabetes mellitus, hyperlipidemia, thyroid abnormalities, acanthosis nigricans, and multiple STs in a Greek primary population. Methods: Phototype and body weight were recorded. Fasting serum blood samples were analyzed for cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, glucose, and thyroid-stimulating hormone. Univariate ordinal logistic regression multivariate analysis was performed. Results: The univariate analysis showed that patients who were overweight with Fitzpatrick Skin Type III, acanthosis nigricans, and hypothyroidism were more likely to present with multiple skin tags as compared with patients at a normal weight with Skin Type I. Statistically significant associations were also found with the presence of cholesterol and triglycerides. In the multivariate analysis, a significant association between hypercholesterolemia and STs was demonstrated. Those with skin tags were more likely to have hypothyroidism. Conclusion: STs are often associated with obesity. An association between lipid profile and STs has been reported. Multiple STs have been independently associated with acanthosis nigricans. Although a possible relationship between STs and thyroid disease has not yet been proved, our review reveals a possible trend. Future investigations with larger sample sizes might clarify the association between skin tags and hypothyroidism.

A comparison study of lipid profile levels between skin tags affected people and normal population in Tehran, Iran

Background:

For many years the association of skin tags and endocrynopathies has been postulated, although many reports are available but it has never been evaluated to mean normal population. Dyslipidemia is a frequent disorder among people and seemed to be necessary for screening within skin tag condition. This study is designed to find any possible association between skin tags and dyslipidemia.

Materials and Methods:

From April 2009 to June 2011, 168 patients enrolled the study. Among the remaining 152 patients, there were 89 females (58.5%) and 63 males (%41.5). Based on the TLGS study 136 men and 220 women enrolled the control group of study. The mean age was 28.4 years. Patients trained to have normal free diet for at least 1 month then referred to the laboratory. Blood samples were taken over 12 hours fasting with 2 hours intervals. Hypertriglyceridemia was defined as plasma level ≥160 mg/dl for men and ≥130 mg/dl for women. Hypercholesterolemia pointed at its value >200 mg/dl. Normal HDL levels was defined as >39 mg/dl for men and >35 mg/dl to women.

Results:

Mean skin tag number was 12.6 per subject. The most frequent localizations of skin tags were neck and upper chest (mean number: 13.4, 48.9%) followed by axilla (mean number: 11.6, 33%) and breast (10.2, 10.1%) in the patient group. The mean cholesterol level of case group was 192.2 ± 33.1 mg/dl, while it was 187.0 ± 42 mg/dl in the control group). The mean ± SD for triglyceride was 132.1 ± 69 mg/dl in comparison to 129 ± 74 in the control group.

Conclusion:

The study showed no significant differences between normal population and patients’ lipid profile.

The Evaluation of the Impact of Age, Skin Tags, Metabolic Syndrome, Body Mass Index, and Smoking on Homocysteine, Endothelin-1, High-sensitive C-reactive Protein, and on the Heart

BACKGROUND

Skin tags (STs) are small, pedunculated skin-colored or brown papules that occur around any site where skin folds occur. The literature is short of comprehensive and controlled clinical studies aimed to evaluate the atherogenic risk factors in patients with STs.

AIM OF WORK

The aim of this study is to evaluate the impact of age, STs, metabolic syndrome (METs), body mass index (BMI), and smoking on homocysteine (Hcy), endothelin-1 (ET-1), high-sensitive C-reactive protein (Hs-CRP), and on cardiovascular diseases.

MATERIALS AND METHODS

This study included 30 cardiac patients with STs, 30 non-cardiac patients with STs, and 30 healthy controls with neither heart disease nor STs. History of smoking, measurement of height, weight, BMI, waist circumference (WC), blood pressure, STs number, color, acanthosis nigricans, estimation of serum level of fasting glucose, triglycerides (TGs), cholesterol, high-dense lipoproteins (HDL), Hcy, ET-1, Hs-CRP, and the presence of the METs were elicited in the three groups.

RESULTS

Regarding the Hcy, ET-1, and Hs-CRP, the cardiac-STs group showed the highest levels and the control group showed the least (P < 0.001). The percents of patients with METs were 56.7% in the cardiac-STs, 40% in the non-cardiac-STs, and 0% in the control group (P < 0.001). Mean BMI exceeded the limit of obesity in the cardiac-STs group (30.9 ± 3.9) and the non-cardiac-STs group (32.6 ± 6) and was normal in the control group (24.7 ± 2.8). Hyperpigmented STs were present in 66.7% of the cardiac-STs group. Multivariate regression analysis for the independent effectors on Hcy level were the presence of STs (P < 0.001), METs (P = 0.001), and BMI (P = 0.024). Regarding ET-1, the effectors were the presence of STs and METs (P = 0.032). For Hs-CRP, effectors were the presence of STs (P < 0.001) and smoking (P = 0.040). Multivariate logistic regression of the predictors of cardiac disease showed that the independent predictors of the occurrence of cardiac disease were BMI (P < 0.001), STs (P = 0.002), and METs (P = 0.037).

CONCLUSION

STs may act as a physical sign of underlying raised cardiac atherogenic factors. This may indicates an ongoing risk on coronary circulation which may indicate further corrective action, hopefully early enough. The association of ST with obesity and METs represents a Bermuda Triangle that act against the heart.

Skin tags and acanthosis nigricans in patients with hepatitis C infection in relation to insulin resistance and insulin like growth factor-1 levels

BACKGROUND

Skin tags (ST) are papillomas commonly found in the neck, axillae of middle-aged and elderly people

AIM

Insulin and insulin-like growth factor (IGF-1) levels are affected by hepatitis C virus (HCV) infection and both of them may be implicated in the etiopathogenesis of ST and acanthosis nigricans (AN) through their proliferative and differentiating properties. So, the aim of this work was to evaluate the impact of HCV infection on ST and AN through the estimation of insulin resistance and IGF-1.

MATERIALS AND METHODS

PARTICIPANTS WERE ARRANGED INTO FOUR GROUPS: (ST +ve / HCV +ve) 23 subjects, (ST+ / HCV -ve) 19 subjects, (HCV -ve / ST-ve) 20 subjects and (ST-ve /HCV +ve) 22 subjects. Age, ST size, color, number, AN, fasting glucose, fasting insulin, insulin resistance, IGF-1, HCV-antibodies (Ab) were recorded.

RESULTS

The mean number of ST in Group 1 was half the number of ST in Group 2 (11.0±9.3 / 22.3±14.0) (P=0.005). The difference in insulin resistance between the same groups was non-significant (13.1±10.6 / 9.0±5.5) (P=0.441) while the difference in IGF-1 was statistically significant (218.6±46.2 /285.4±32.8) (P=0.002). The multivariate logistic regression for the variables revealed that insulin resistance is the only factor affecting the occurrence of ST (OR=1.096, P=0.023). Multivariate regression analysis for the variables showed that HCV was borderline but not a significant factor affecting the number of ST (Beta=-0.409, P=0.053). The number of patients with AN was doubled in Group 2 in comparison to Group 1 but this was non significant 3(13%) / 6(32%) (P=0.2800).

CONCLUSION

HCV is associated with a significant decrease in the ST number and in the serum level of IGF-1 together with an obvious decrease in the occurrence of AN. Our results may point to the entrant effect of insulin resistance and IGF-1 in ST and AN development. The current study suggests the evaluation of IGF-1-lowering agents in the control of ST and AN especially in the females with polycystic ovary and in the prevention of the recurrence of ST after surgical removal.

A clinical evaluation of skin tags in relation to obesity, type 2 diabetis mellitus, age, and sex

BACKGROUND

Skin tags (STs) have been investigated as a marker of type 2 diabetes mellitus (DM), yet the relation of STs to obesity is still a matter of controversy.

AIM

The aim of the study is to explore the relation of number, size and color of STs to obesity, diabetes, sex and age in one study.

METHODS

The study included 245 nondiabetic (123 males and 122 females) and 276 diabetic (122 males and 154 females) subjects. We recorded age, sex, body mass index (BMI), relevant habits, STs color, size, and number in different anatomical sites.

RESULTS

The presence and the mean number of STs was more in obese than nonobese participants (P = 0.006 and P < 0.001, respectively) and was not affected by sex. However, the number increased significantly with age. The presence of mixed-color STs was related to obese (P < 0.001) participants. Multivariate logistic regression revealed that only BMI was significantly associated with the mixed-color STs (OR = 3.5, P < 0.001). The association of DM (OR = 1.7) with mixed-color STs was nonsignificant (P = 0.073). Neither age nor sex had any association with mixed-color STs. Within cases that developed mixed-color STs, the multivariate analysis showed that only BMI had a significant correlation to the number of STs (beta = 0.256, P = 0.034).

CONCLUSION

The study showed that not only the number but also the presence of mixed-color ST was related to obesity, but not to diabetes. The presence of mixed-color STs in nondiabetic subjects needs close inspection of BMI.

A study of androgen and estrogen receptors alpha, beta in skin tags

Background:

In women, the age of 50 is suggested to be the turning point of life at which the development of skin tags comes to a stop. A major event that occurs around this period of life is menopause/andropause. After menopause, estrogen receptors amounts decrease significantly. As skin is considered as the largest nonreproductive target on which estrogens and androgens act, we assume a possible relationship between the pathogenesis of skin tags and sex steroid balance. Another phenomenon is the association of skin tags in obese patients, which may also be explained by the interplay of sex steroids and their receptors in skin tags.

Aims:

Here we see that in obese patients, hyperandrogenism occurs as a result of hyperinsulinemia as well as peripheral conversion of estrogens into androgens in the excessive adipose tissue. To examine the possible role of androgen and estrogen receptors in etiopathogenesis of skin tags.

Materials and Methods:

To examine these hypotheses, we measured the level of androgen and estrogen receptors (both α and β) in skin tags compared to control. We also correlated the level of receptors to body mass index, and compared those levels in patients with acanthosis nigricans compared to normal.

Results:

The level of estrogen receptors (both α and β) was significantly higher in skin tags than in controls with a P value of 0.004 and 0.001, respectively. The same upsurge was found for androgen receptors in skin tags relative to control with a P value of 0.001. No statistically significant difference in receptor level was found either among patients with acanthosis nigricans and those without, or in correlation to body mass index (our participants were overweight non diabetic).

Conclusion:

These results suggest the possible role of androgen and estrogen receptors in etiogenesis of skin tags, and propose that the neck is an androgen dependent area just similar to the axillae and the groins, though hairless.

Serum leptin, atherogenic lipids and glucose levels in patients with skin tags

Aim:

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

Materials and Methods:

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

Results:

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

Conclusion:

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

Quantitation of mast cells and collagen fibers in skin tags

BACKGROUND

Skin tags are common benign skin tumors usually occurring on the neck and major flexors of elder people.

AIMS

The aim of this study is to perform quantitation of mast cells and collagen fibers in skin tags and normal skin in diabetics and nondiabetics, to find a possible correlation between mast cells and collagen fibers in the pathogenesis of skin tags.

METHODS

Thirty participants with skin tags were divided into two groups (15 diabetic and 15 nondiabetic). Three biopsies were obtained from one anatomical site: A large skin tag, a small skin tag, and adjacent normal skin. Mast cells stained with Bismarck brown were counted manually in ten different fields of each section with magnification x1000 and the average count was correlated with the percentage of mean collagen area in five fields done by the image analyzer.

RESULTS

A statistically significant correlation between mast cell count and percentage of collagen mean area was detected in both studied groups (except in large skin tags of the nondiabetic group).

CONCLUSION

The positive correlation between mast cell count and percentage of collagen mean area suggests the critical role of mast cells in the etiogenesis of skin tags through its interaction with fibroblasts.