A Primer of Skin Diseases Associated With Obesity

Noah S Scheinfeld; Daniel H Parish; Lawrence Charles Parish

Disclosures

Expert Rev Dermatol. 2007;2(4):409-415. 

In This Article

Dermatologic Conditions Associated With Obesity

Acrochordons, also known as skin tags and fibroepitheliomas, are pedunculated, often brown papules, that have a propensity for the necks of obese patients. At one time, rubbing or maceration of the nuchal tissue was thought to cause these warty-like lesions; however, their morphology suggests that papilloma viruses play a role in their development. These lesions appear to be associated with impaired carbohydrate metabolism and increased atherosclerosis.[17,18] Some studies suggest that acrochordons are linked to the presence of diabetes, which itself is a risk factor for obesity, rather than being independently associated with obesity.[19] Skin tags require no intervention but are readily destroyed by snipping or electrodessication.

Among the most commonly encountered dermatoses in obese patients is acanthosis nigricans (AN); however, it cannot be predicted which obese patient will be affected (Figure 1). While classically associated with an underlying malignancy, AN appears to be tightly linked to diabetes and obesity. This is explained by the observations that obese patients have higher levels of insulin than people who are not obese.[19]

Acanthosis nigricans.

The foundations of AN are cellular insulin resistance, increased insulin production, stimulation of IGF receptors by insulin and IGF receptor induction of keratinocyte proliferation.[20] This results in a thickening of the skin and no change in pigmentation. The relative velvety darkness on the nape, on the axillae, and under the breasts is due to hyperkeratosis. AN was observed in 74% of patients with obesity, with patients who are of African-American descent having a higher incidence than white patients. Patients with AN have fasting plasma insulin levels higher than those who do have manifestations of AN.[21] Obese children, as well as individuals of Native American or African-American descent, have a higher incidence of AN.[20]

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