To view enhanced content for this article go to http://www.medengine.com/Redeem/8627F0604A688070.
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.
Boyle J, Thompson T, Gregg E, Barker L, Williamson D. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010;8:1. CrossRef
Napolitano M, Megna M, Monfrecola G. Insulin resistance and skin diseases. Sci World J. 2015. doi: 10.1159/000245731.
Shanik MH, et al. Insulin resistance and hyperinsulinemia: Is hyperinsulinemia the cart or the horse? Diabet Care. 2008;31:262–8. CrossRef
Hermanns-Lê T, Scheen A, Piérard GE. Acanthosis nigricans associated with insulin resistance. Am J Clon Dermatol. 2004;5:199–203. CrossRef
Murphy-Chutorian B, Han G, Cohen SR. Dermatologic manifestations of diabetes mellitus. a review. Endocrinol Metab Clin N Am. 2013;42:869–98. CrossRef
Margolis J, Margolis LS. Skin tags-a frequent sign of diabetes mellitus. N Engl J Med. 1976;294:1184. PubMed
Kahana M, et al. Skin tags: a cutaneous marker for diabetes mellitus. Acta Derm Venereol. 1987;67:175–7. PubMed
Men J, Boberg J. Fibroepithelial polyps. An unusual case report. J Am Podiatr Med Assoc. 1990;80:496–8. CrossRef
Kamino H, Reddy VB, Pui J. Dermatology. Philadelphia: Elsevier; 2012. p. 1961.
Brinster NK, Liu V, Diwan AH, McKee PH. Dermatopathology: high-yield pathology. Edinburgh: Elsevier; 2011. p. 446.
Pfenninger JL. Pfenninger and Fowler’s Procedures for Primary Care. Philadelphia: Elsevier; 2011. p. 69–84. CrossRef
Dobrev D. Case of acanthosis nigricans associated with gastric cancer. Suvr Med. 1958;9:100–3.
Lindewall G. Acanthosis nigricans associated with carcinoma of the stomach: a case report. Acta Derm Venereol. 1960;40:493–9. PubMed
Pollitzer S. Acanthosis nigricans: a symptom of a disorder of the abdominal sympathetic. JAMA. 1909;53:1369–73. CrossRef
Janovsky V. Acanthosis nigricans. In: Unna PG, Morris M, Besnier E, editors. International atlas of rare skin diseases. London: HK Lewis & Co; 1891. p. 4–5.
Burke JP, Hale DE, Hazuda HP, Stern MP. A quantitative scale of acanthosis nigricans. Diabet Care. 1999;22:1655–9. CrossRef
Gómez-Flores M, et al. Implications of a clinically ignored site of acanthosis nigricans: the knuckles. Exp Clin Endocrinol Diabet. 2014;123:27–33. CrossRef
Muñoz-Pérez MA, Camacho F. Acanthosis nigricans: a new cutaneous sign in severe atopic dermatitis and Down syndrome. J Eur Acad Dermatol Venereol. 2001;15:325–7. PubMed
Higgins SP, Freemark M, Prose NS. Acanthosis nigricans: a practical approach to evaluation and management. Dermatol Online J. 2008;14:2. PubMed
Adigun C, Pandya A. Improvement of idiopathic acanthosis nigricans with a triple combination depigmenting cream. J Eur Dermatol Venereol. 2009;23:486–7. CrossRef
Blobstein SH. Topical therapy with tretinoin and ammonium lactate for acanthosis nigricans associated with obesity. Cutis. 2003;71:33–4. PubMed
Sperling LC, SInclair R, Shabrawi-Caelen L. Dermatology. Philadelphia: Elsevier; 2012. p. 1093–8.
Gonzalez-Gonzalez JG, Mancillas-Adame LG, Fernandez-Reyes M, Lavalle-Gonzalez FJ, Ocampo-Candiani J. Androgenetic alopecia and insulin resistance in young men. Clin Endocrinol. 2009;71:494–9. CrossRef
Otberg N, Finner AM, Shapiro J. Androgenetic Alopecia. Endocrinol Metab Clin N Am. 2007;36:379–98. CrossRef
Sawaya M, Shalita A. Androgen receptor polymorphisms (CAG repeat lengths) in androgenetic alopecia, hirsutism, and acne. J Cutan Med Surg. 1998;3:9–15. PubMed
Blumeyer A, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. J Dtsch Dermatol Ges. 2011;9:1–57. CrossRef
Vryonidou A, Paschou S, Muscogiuri G, Orio F, Goulis D. Metabolic Syndrome through the females life cycle. Eur J Endocrinol. 2015;1:153. CrossRef
Poretsky L, Piper B. Insulin resistance, hypersecretion of LH, and a dual-defect hypothesis for the pathogenesis of polycystic ovary syndrome. Obs Gynecol. 1994;84:613–21.
Housman E, Reynolds RV. Polycystic ovary syndrome: a review for dermatologists Part I. Diagnosis and manifestations. J Am Acad Dermatol. 2014;71:847-e1. CrossRef
Knochenhauer E, et al. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. J Clin Endocrinol Metab. 1998;83:3078–82. PubMed
Rosenfield RL. Hirsutism. NEJM. 2005;24:2578–88. CrossRef
Claman P. SOGC clinical practice guidelines. Hirsutism: evaluation and treatment. J Obs Gynaecol Can. 2002;24:62–73. CrossRef
Hohl A, Ronsoni MF, Oliveira M. Hirsutism: diagnosis and treatment. Arq Bras Endocrinol Metab. 2014;58:97–107. CrossRef
Demir B, et al. Changes in serum desnutrin levels in patients with acne vulgaris. Eur J Dermatol. 2014;24:589–93. PubMed
Buzney E, Sheu J, Buzney C, Reynolds R. Polycystic ovary syndrome: A review for dermatologists: Part II. Treatment. J Am Acad Dermatol. 2014;71:859-e1. CrossRef
- Skin Manifestations of Insulin Resistance: From a Biochemical Stance to a Clinical Diagnosis and Management
José Gerardo González-González
- Springer Healthcare
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II