Management of large multiple oral papillary lesions suspected Acanthosis Nigricans: a case report

Background Papillary oral pathologies are a heterogenous group. Both virus-associated and non-virus-associated, malignant and benign entities may enter the differential diagnosis. In some cases, oral papillary lesions are part of a variety of skin or systemic disorders and syndromes. It is a challenge for clinicians to identify and treat the various etiology of oral papillary lesions. Case presentation This case report describes the successful management of large multiple oral papillary lesions in a 65-year-old female. Combined the clinical features, pathological findings and medical history, the patient was tended to be the diagnosis of Acanthosis Nigricans and was successfully managed. The neuro-endocrine-immune network and mechanical factors in the pathogenesis of oral papillary lesions of Acanthosis Nigricans were discussed. Common questions regarding differential diagnosis, the management of oral papillary lesions of Acanthosis Nigricans patients and follow-up visits are addressed. Conclusions The neuro-endocrine-immune network and mechanical factors play important roles in the pathogenesis of oral papillary lesions with Acanthosis Nigricans. Removing traumatic factors of oral mucosa and the treatment of underlying systemic diseases is necessary for Acanthosis Nigricans patients with oral papillary lesions. The clinical management plan should comprise both the local treatments of oral papillary lesions and the systemic treatment of underlying diseases. Multidisciplinary correlation is helpful and the patient’s collaboration is necessary to arrive at the correct diagnosis and successful long-term treatment effect. From the clinician’s perspective, recognizing various causes and clinical presentations of oral papillary lesions will help guide management.

Bullous Disease of Diabetes (Bullosis Diabeticorum)

Acanthosis nigricans, acrochordrons, diabetic dermatopathy, necrobiosis lipoidica, and bullous diabeticorum are some of the cutaneous symptoms of diabetes. Bullous illness (bullosis diabeticorum) is a blistering, non-inflammatory condition of the acral skin. Diabetes bullous illness is more common in people who have had diabetes for a long time or who have many comorbidities. Although the actual cause is uncertain, it is likely to be multifactorial. Neuropathy, nephropathy, vasculopathy, and UV (ultraviolet) light are all suggested to have a role. BD is most likely caused by the various problems that come with poorly managed diabetes. The exact number of people who have BD is unknown. The majority of case studies in the literature were based on a small number of cases. Bullous diabeticorum is a restrictive diagnosis, which necessitates a histological study that includes direct immunofluorescence to rule out other vesicobullous illnesses. In terms of BD management, no strong consensus has formed. The blisters have historically been thought to be self-limiting, with bullae resolving in 2 to 6 weeks if left untreated. In some cases antibiotic may be used. In this article we’ll be looking at Bullosis Diabeticorum. Its etiology, epidemiology, diagnosis, and treatment.

Different patterns of cutaneous manifestation of diabetes mellitus type-2 observed in tertiary care centre of South West Rajasthan

Diabetes mellitus (DM) is a common endocrinal disorder caused by complex interaction of genetics and environmental factors. Various dermatological features are known to be cutaneous markers of diabetes mellitus like diabetic dermatopathy, acrochordons, acanthosis nigricans and bullous diabeticorum, etc. An observational cross-sectional study on a total of 400 patients of Diabetes Mellitus Type-2. A complete cutaneous examination was done in all cases to observe for the presence of any specific or nonspecific dermatosis. All the statistical tests were two sided and P-value <0.05 was considered as significant level. This study showed that in specific cutaneous disorders, Acrochordon 138(34.5%) was the most common manifestation which was followed by, Bacterial Infections 93(23.5%), Dermatophytosis 77(19.2%), Candidiasis 76(19%), Acanthosis nigricans 50(12.5%) and Onychomycosis 33(8.25%) in decreasing order. Xerosis 259(64.7%) was the commonest manifestation in non-specific cutaneous disorders followed by, Generalized pruritus 200(50%), Seborrheic keratosis 35(8.75%) in decreasing order. Cutaneous manifestations are quite common in uncontrolled (HbA1c>7gm) type 2 diabetes mellitus as compare to controlled group. Uncontrolled group is more prone to develop diabetic complication like hypertension, diabetic retinopathy and peripheral neuropathy etc. It is concluded that, Diabetes mellitus Type-2 involves the skin quite often and whenever patients present with multiple skin manifestation and then diabetic statusshould be checked and controlled.

Lawrence Syndrome “acquired generalized lipodystrohy” with type 1 diabetes mellitus in 7 years boy of Bahawalpur

Lipodystrophy syndromes are rare disorders characterized by either generalized or partial lack of adipose tissue. They are congenital or acquired. These syndromes are associated with various metabolic and harmonal disorders leading to severe comorbidities including hypertriglyceridemia, diabetes mellitus, acanthosis nigricans, xanthomas, polycystic ovarian syndrome (POS) and non-alcoholic fatty liver disease. Keywords: Lawrence syndrome, lipodystrophy, diabetes mellitus

Clinical Evaluation of Acanthosis Nigricans and Its Correlation with Endocrine, Metabolic and Nutritional Factors in Gujarat, India

Acanthosis nigricans (AN) refers to the velvety, black hyperpigmentation in flexures usually on the neck and axillae. AN is associated with multiple endocrinopathies and insulin resistance is reported to be a common denominator among them. The aim of the study was to identify the correlation of metabolic factors (Serum glucose, lipid profile), endocrine factors (TSH, serum insulin), and nutritional factors (vitamin B12, Ferritin) in AN patients in Aravalli district of Gujarat state. A total of Seventeen Patients (11 male and 6 female) were included in the study History, clinical observations, physical parameters, and biochemical tests were noted in AN patients and correlation of some likely factors with AN was explored. The age was 28.41±15.09 years for AN group and 35.45±8.74 years for the control group. The mean BMI was found to be higher in AN at 1 % level of significance (P = 0.007) implying that overweight/obesity is associated with AN. The mean TSH value was found to be higher in AN than control group at 5 % level of significance (P = 0.0115) implying that hypothyroidism (elevated TSH value) is associated with AN. The 45.45 % patients had higher blood glucose levels and some of the patients had higher level of insulin. The mean lipid profile, vitamin B12 and serum ferritin were found to be at non-significance level. All statistical tests were performed using graph pad prism software (version 5.0). Positive correlations were observed between higher fasting glucose and hyperinsulinemia with AN and others factors such as metabolic and endocrine like overweight/obesity, hypothyroidism, higher glucose and serum insulin with AN. This implies that AN can serve as a marker for detecting hyperinsulinemia and hypothyroidism. Some of the parameters like, Serum lipid profile, vitamin B12 and ferritin levels could not be correlated to AN. Thus, patients with AN can be targeted for lifestyle and behavioral modifications at an early stage to avoid the serious consequences of AN.

Abdominal wall skin lesions in adult morbid obese women

Objective: To present only skin lesions in the abdominal wall that we detected in morbidly obese patients and to examine them in the light of the literature. Material and Method: Patients who applied to the general surgery outpatient clinic for bariatric surgery and who also had dermatological complaints and were referred to the dermatology outpatient clinic with the detection of skin-related complaints were retrospectively evaluated in terms of age and breast skin findings. Normal skin findings were separated into intertrigo, chronic recurrent folliculitis, eczemas, acanthosis nigricans and striae. Results: A total of 60 obese female patients were included in the study. The mean age of the patients was 32.4 ± 8.8 years (19-53), and the mean body mass index was 42.6 ± 2.4 (40-49). Normal skin findings were present in 28.3% of the patients (17 patients). The most common finding was striae, and 60% (36 patients) had it. Then respectively, intertrigo was detected in 14 patients (23%), chronic recurrent folliculitis in 12 patients (20%), eczema in 5 patients (8.3%), and acanthosis nigricans in 2 patients (3.3%). Conclusion: The most common findings on the abdominal wall skin of obese individuals are striae and intertrigo, and similar findings have been found in many studies in the literature.

Prevalence of pre-diabetes in adolescents aged 11-17 years with high risk factors

Background: Obesity is a rising global epidemic in children which leads to pre-diabetes and overt diabetes. Identification at early stage helps in early intervention. This study was undertaken to study the prevalence of pre-diabetes in urban school going adolescents aged 11-17 years with high risk factors.Methods: This was a prospective cross-sectional study conducted in Chennai, India between December 2011 and November 2012. Overweight or obese adolescents in the age group 11-17 years, either with family history of diabetes or acanthosis nigricans or both were included. After obtaining informed consent from parents, history was obtained in pre-tested questionnaire.Results: 148 adolescents were enrolled in the study (n=148), 71.62% were females, mean weight was 59.54±10.44 kg, mean height was 150.92±8.62 cm, mean BMI was 26.19±3.23 and mean blood glucose was 82.1 mg/dl. 60.81% of subjects were overweight and others obese. Girls had statistically significant higher mean weight and mean BMI than boys. 78.37% had acanthosis nigricans, 47.29% had family history of diabetes, 12.16% had pre-diabetes and the mean blood glucose in pre-diabetics was 104.9 mg/dl. Pre-diabetes was higher in adolescents with family history of diabetes (p=0.038).Conclusions: Recognition of risk of type 2 diabetes in the asymptomatic pre-diabetes phase needs to be emphasized and targeted screening of high risk children for pre-diabetes seems to be justified. The morbidity and mortality of youth onset type 2 diabetes can be reduced only by early detection and treatment.