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Table of Contents
LETTER TO THE EDITOR
Year : 2012  |  Volume : 16  |  Issue : 6  |  Page : 1058-1059

Atypical presentation of acanthosis nigricans


1 Department of Medicine, KPC Medical College, Kolkata, West Bengal, India
2 Department of Medicine, R.G. Kar Medical College, Kolkata, West Bengal, India

Date of Web Publication31-Oct-2012

Correspondence Address:
Nirmalya Roy
3/H Dover Terrace, Kolkata-700 019
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.103048

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How to cite this article:
Roy N, Das T, Kundu AK, Maity A. Atypical presentation of acanthosis nigricans. Indian J Endocr Metab 2012;16:1058-9

How to cite this URL:
Roy N, Das T, Kundu AK, Maity A. Atypical presentation of acanthosis nigricans. Indian J Endocr Metab [serial online] 2012 [cited 2019 Nov 18];16:1058-9. Available from: http://www.ijem.in/text.asp?2012/16/6/1058/103048

Sir,

We document one case of acanthosis nigricans (AN) in an atypical site.

The patient was a 48-year-old achondroplastic, diabetic male, school teacher by profession with a body mass index (BMI) of 26 kg/m 2 . His clinical examination revealed AN over the nape of the neck, axilla, and forehead [Figure 1]. He had normal developmental milestones, and other systemic examinations were essentially within normal limits. Laboratory investigations revealed glycosylated hemoglobin of 8.6% and dyslipidemia (total cholesterol level of 375 mg/dl, low density lipoprotein level of 195 mg/dl, triglyceride level of 180 mg/dl, and high density lipoprotein level of 36 mg/dl). There was no evidence of internal malignancy in chest radiography, abdominal ultrasound, upper gastrointestinal endoscopy, and colonoscopy.
Figure 1: Acanthosis nigricans seen on forehead

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AN is a brown-to-black velvety hyperpigmentation of skin. The common sites involved are posterior and lateral folds of neck, axilla, umbilicus, and groin. [1] Forehead, oral mucosa, and eyelids are rarely involved. It may be mistaken with giant melanocytic nevus, atrophic seborrheic dermatitis, hemochromatosis, or atopic dermatitis. AN is associated with insulin resistance states like type 2 diabetes, polycystic ovarian syndrome, and obesity. Crouzon's syndrome and Costello's syndrome are also associated with AN. Severe achondroplasia with developmental delays and AN (SADDAN) have been documented. [2] As in our case, achondroplasia without the presence of developmental delays and AN have also been reported. AN is a paraneoplastic manifestation of internal malignancies of stomach, gut, ovary, prostate, and others. AN is a clinical diagnosis only rarely requiring a skin biopsy. However, a meticulous search for underlying disease and malignancy is required. Treatment of AN involves treatment of the underlying disease or tumor, avoidance of precipitating drugs like niacin, steroids, protease inhibitors, and use of topical keratinolytics, oral isotretinoin, metformin, and ultimately, cosmetic surgery. [3]

 
   References Top

1.Kundu AK. Acanthosis nigricans revisited. J Assoc Physicians India 2001;49:1003-6.  Back to cited text no. 1
[PUBMED]    
2.Vajo Z, Francomano CA, Wilkin DJ. The molecular and genetic basis of fibroblast growth factor receptor 3 disorders: The achondroplasia family of skeletal dysplasias, Muenke craniosynostosis, and Crouzon syndrome with acanthosis nigricans. Endocr Rev 2000;21:23-39.  Back to cited text no. 2
[PUBMED]    
3.Walling HW, Messingham M, Myers LM, Mason CL, Strauss JS. Improvement of acanthosis nigricans on isotretinoin and metformin. J Drugs Dermatol 2003;2:677-81.  Back to cited text no. 3
[PUBMED]    


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