Childhood acanthosis nigricans in HRH Princess Maha Chakri Sirindhorn Medical Center

Arucha Treesirichod; Nattakarn Wongjitrat

Authors

Arucha Treesirichod DERMATOLOGY UNIT, DEPARTMENT OF PEDIATRICS, FACULTY OF MEDICINE, SRINAKHARINWIROT UNIVERSITY, BANGKOK, THAILAND
Nattakarn Wongjitrat DERMATOLOGY UNIT, DEPARTMENT OF PEDIATRICS, FACULTY OF MEDICINE, SRINAKHARINWIROT UNIVERSITY, BANGKOK, THAILAND

Keywords:

Acanthosis nigricans, obesity, glucose intolerance, children

Abstract

Background: Acanthosis nigricans was increased among children population with obesity. In published data, insulin resistance and type 2 diabetes were implicated as etiologic factors of hyperpigmented dermatologic finding.

Objective: To study the clinical and epidemiologic profiles of childhood acanthosis nigricans and determine the prevalence and associated factors with the glucose intolerance.

Methods: Patients with acanthosis nigricans were evaluated by history taking and physical examination. The information of weight, height, body mass index, weight for height and distribution of acanthosis nigricans were recorded. Glucose tolerance test were performed.

Results: Thirty-six patients with acanthosis nigricans, 22 males (61.1 %) and 14 females (38.9 %) with an average age of 9.8 + 3.9 years and mean body weight of 65.3 + 25.6 kg were enrolled in this study. Of these, 35 patients (97.2 %) were overweight with BMI for age above 85^th percentiles. Posterior neck fold was the most common involved location while the axilla was subsequently affected herein. One each patient (2.8 %) was noted with lipodystrophy and polycystic ovary syndrome. Twenty-four patients were performed glucose tolerance test. Five patients (20.8 %) demonstrated an impaired glucose tolerance test. No significant correlation between glucose intolerance and weight, height, body mass index, weight for height and distribution of acanthosis nigricans.

Conclusions: Considerable prevalence of impaired glucose tolerance test was observed in obese children with acanthosis nigricans. Recognition of this entity will be essential to identify relevant medical conditions particularly insulin resistance and childhood-onset diabetes.

References

Brickman WJ, Binns HJ, Jovanovic BD, Kolesky S, Mancini AJ, Metzger BE. Acanthosis nigricans: a common finding in overweight youth. Pediatr Dermatol. 2007;24:601-6.

Friedman CI, Richards S, Kim MH. Familial acanthosis nigricans: a longitudinal study. J Reprod Med. 1987;32:531-6.

Guran T, Turan S, Akcay T, Bereket A. Significance of acanthosis nigricans in childhood obesity. J Pediatr Child Health. 2008;44:338-41.

Litonjua P, Pinero-Pilona A, Aviles-Santa L, Raskin P. Prevalence of acanthosis nigricans in newly-diagnosed type 2 diabetes. Endocr Pract. 2004;10:101-6.

Schwartz RA. Acanthosis nigricans. J Am Acad Dermatol. 1994;31:1-19.

American Diabetes Association. Type 2 diabetes in children and adolescents: consensus statement. Diabetes Care. 2000;1:80-6.

Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA. 2002;288:1728-32.

Varthakavi PK, Waingankar A, Patel KL, Wadhwa SL, Khopkar U, Sengupta RA, et al. Acanthosis nigricans: a dermatologic marker of metabolic disease. Indian J Dermatol Venereol Leprol. 2002;68:67-72.

Bolding J, Wratchford T, Perkins K, Ogershok P. Prevalence of obesity, acanthosis nigricans and hyperinsulinemia in an adolescent clinic. W V Med J. 2005;101:112-5.

Langendijk G, Wellings S, van Wyk M, Thompson SJ, McComb J, Chusilp K. The prevalence of childhood obesity in primary school children in urban Khon Kaen, northeast Thailand. Asia Pac J Clin Nutr. 2003;12:66-72.

Sakamoto N, Wansorn S, Tontisirin K, Marui E. A social epidemiologic study of obesity among preschool children in Thailand. Int J Obes Relat Metab Disord. 2001;25:389-94.

Pawloski LR, Ruchiwit M, Pakapong Y. A cross-sectional examination of growth indicators from Thai adolescent girls: evidence of obesity among Thai youth? Ann Hum Biol. 2008;35:378-85.

Chang Y, Woo HY, Sung E, Kim CH, Kang H, Ju YS, et al. Prevalence of acanthosis nigricans in relation to anthropometric measures: community-based cross-sectional study in Korean pre-adolescent school children. Pediatr Int. 2008;50:667-73.

Stuart CA, Pate CJ, Peters EJ. Prevalence of acanthosis nigricans in an unselected population. Am J Med. 1989;87:269-72.

Nguyen TT, Keil MF, Russell DL, Pathomvanich A, Uwaifo GI, Sebring NG, et al. Relation of acanthosis nigricans to hyperinsulinemia and insulin sensitivity on overweight African American and white children. J Pediatr Child Health. 2001;138:474-80.

Lopez-Alvarenga JC, García-Hidalgo L, Landa-Anell MV, Santos-Gómez R, González-Barranco J, Comuzzie A. Influence of skin color on the diagnosis utility of clinical acanthosis nigricans to predict insulin resistance in obese patients. Arch Med Res. 2006;37:744-8.

Copeland K, Pankratz K, Cathey V, Immohotichey P, Maddox J, Felton B, et al. Acanthosis nigricans, insulin resistance (HOMA) and dyslipidemia among Native American children. J Okla State Med Assoc. 2006;99:19-24.

Kobaissi HA, Weigensberg MJ, Ball GD, Cruz ML, Shaibi GQ, Goran MI. Relation between acanthosis nigricans and insulin sensitivity in overweight Hispanic children at risk for type 2 diabetes. Diabetes Care. 2004;27:1412-6.

Yamazaki H, Ito S, Yoshida H. Acanthosis nigricans is a reliable cutaneous marker of insulin resistance in obese Japanese children. Pediatr Int. 2003;45:701-5.

Vutyavanich T, Khaniyao V, Wongtra-Ngan S, Sreshthaputra O, Sreshthaputra R, Piromlertamorn W. Clinical, endocrine and ultrasonographic features of polycystic ovary syndrome in Thai women. J Obstet Gynaecol Res. 2007;33:677-80.

Charnvises K, Weerakiet S, Tingthanatikul Y, Wansumrith S, Chanprasertyothin S, Rojanasakul A. Acanthosis nigricans: clinical predictor of abnormal glucose tolerance in Asian women with polycystic ovary syndrome. Gynecol Endocrinol. 2005;21:161-4.

Bhattacharya SM. Insulin resistance and overweight-obese women with polycystic ovary syndrome. Gynecol Endocrinol. 2010;26:344-7.

Sudy E, Urbina F, Maliqueo M, Sir T. Screening of glucose/insulin metabolic alterations in men with multiple skin tags on the neck. J Dtsch Dermatol Ges. 2008;6:852-5.