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. 2017 Nov-Dec;62(6):591-597.
doi: 10.4103/ijd.IJD_545_17.

Facial Acanthosis Nigricans: A Morphological Marker of Metabolic Syndrome

Saumya Panda  1 , Anupam Das  1 , Koushik Lahiri  2 , Manas Chatterjee  3 , Tanmay Padhi  4 , Sanjay Rathi  5 , Sandipan Dhar  6 , Nilendu Sarma  7
Affiliations

Facial Acanthosis Nigricans: A Morphological Marker of Metabolic Syndrome

Saumya Panda et al. Indian J Dermatol. 2017 Nov-Dec.

Abstract

Introduction: Acanthosis nigricans (AN) is a frequently encountered entity. Facial AN (FAN) is a subset of AN which is being increasingly recognized. Recently, reports hypothesizing the association of FAN with features of metabolic syndrome have been published.

Aims and objectives: The aim of this study was to study the clinicodemographic profile of patients with FAN, and to assess the correlation of hypertension, increased waist-hip ratio (WHR), increased body mass index (BMI), type 2 diabetes mellitus, deranged lipid profile, serum insulin, and impaired oral glucose tolerance test (OGTT) (parameters of metabolic syndrome) in these patients, as well as to determine the most significant predictor (highest relative risk) of development of FAN.

Methods: A multicentric case-control study was conducted (123 cases in each group) over a period of 2 years. Data were obtained on the basis of history, examination, and relevant laboratory investigations. Statistical analysis was done using Statistica version 6 (StatSoft Inc., 2001, Tulsa, Oklahoma, USA), SPSS statistics version 17 (SPSS Inc., 2008, Illinois, Chicago, USA), and GraphPad Prism version 5 (GraphPad Software Inc., 2007, San Diego, California, USA).

Results: Mean age of the patients with FAN was 38.83 ± 8.62 years. Mean age of onset of the disease was 30.93 ± 8.18 years. The most common site of face involved was the forehead and temporal region. The most common pigmentation was brown-black. Male sex, positive OGTT, increased WHR, and increased BMI were most significantly related to FAN. Smoking was found to have a protective effect against the development of FAN.

Conclusion: Here, we document a significant association between male patients with positive OGTT, increased WHR, and BMI and FAN. Thus, we propose that FAN could be considered a morphological marker of metabolic syndrome.

Keywords: Case-control study; facial acanthosis nigricans; metabolic syndrome.

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Conflict of interest statement

There are no conflicts of interest. What is new? Facial acanthosis nigricans is a new entity. Male patients, those with elevated HOMA2-IR level, positive oral glucose tolerance test, increased waist hip ratio, and increased body mass index have a significantly higher probability of developing FAN. As per our study, smoking has been found to have a protective role against the development of facial acanthosis nigricans.

Figures

Figure 1
Figure 1
An obese patient with brown-to-black macular pigmentation with blurred margins. Note the characteristic involvement of the zygomatic area, extending downward. The skin is dry, rough, and verrucous
Figure 2
Figure 2
Same patient with lesions of facial acanthosis nigricans on the other side of the face. Note the severity of the presentation, in terms of intense pigmentation and velvety thickening of the skin
Figure 3
Figure 3
Classical morphology of facial acanthosis nigricans can be appreciated over the forehead
Figure 4
Figure 4
An overweight patient with moderate degree of acanthosis nigricans on the forehead
Figure 5
Figure 5
Clinical picture of a middle aged gentleman with normal BMI with mild lesions of FAN. Involvement of the eyelids can be appreciated
Figure 6
Figure 6
Photomicrograph showing hyperkeratosis, papillomatosis, hypermelanization of basal layer, and follicular plugging (H and E, ×100)
Figure 7
Figure 7
Photomicrograph showing hyperkeratosis, mild acanthosis, papillomatosis, follicular plugging and hypermelanisation of the basal layer (H&E, scanner view)
Figure 8
Figure 8
Photomicrograph showing papillomatosis, follicular plugging and intense melanisation of the basal layer (H&E, 100X)
See this image and copyright information in PMC

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