Acanthosis nigricans: Skin conditions and obesity

Obesity is a growing problem in the United States and around the world, particularly in urban areas. 1 During 2011-2014, 36.5% of all Americans were obese, including almost 57% of non-Hispanic black women. 2 Obesity-related medical costs in 2008 were estimated at $147 billion nationwide. More important than the economic consequences, the related health issues include heart disease, stroke, diabetes, and a variety of skin conditions. 3

Heart disease, stroke, and type 2 diabetes are some of the leading causes of preventable death in the United States. 4 These obesity-related conditions have been researched thoroughly, and are given considerable attention in both scientific and popular media publications. The impact of obesity on the skin, however, has received significantly less attention, and is less understood by the general public. Obesity can interfere with the ability of skin to serve as a protective barrier, and can affect sweat glands, wound healing, and circulation. It can also contribute to a number of dermatologic diseases. 5 As the organ devoted to protecting the body from the external environment and to regulating the internal environment, any change in the skin may compromise its important functions. 6

Obesity is associated with a variety of external skin infections and conditions, including acanthosis nigricans: patches that are noticeably darker than the surrounding skin and are commonly observed on the underarms, groin, neck, and other skin folds. 7 These dark, velvety patches can arise from obesity-related insulin resistance, which can affect the color of certain skin cells. 8 Obese individuals have a harder time regulating sugar in the blood, and as a result their bodies release high levels of insulin, a sugar-regulating hormone. 9 Early identification of this condition may facilitate earlier intervention and prevention of insulin-related diseases, including diabetes.

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Bryant and Buck/Acanthosis Nigricans/Public Domain

Screening for acanthosis nigricans is noninvasive and painless, as the condition is exhibited externally.  Although there are treatments available (such as Vitamin A, in the form of pills and creams), these can only help improve the external appearance of the skin, and do not target insulin resistance, the condition’s true cause. Thus, the only truly effective treatments are lifestyle adjustment and obesity management. Public health efforts targeted toward obesity should give greater attention to acanthosis nigricans, both as an indicator of diabetes, and as emotionally distressing and physically harmful symptoms of the disease that can be treated with diet, exercise, and other lifestyle changes. 10

The skin afflictions related to obesity are concerning and significant. Obesity is a major public health issue, and its associated health complications deserve public attention and research efforts. As the heaviest and largest organ, skin has many critical functions that can be severely compromised with extreme weight gain. 11 Although acanthosis nigricans is not a major cause of death in the US, it can serve as a signal of obesity-related health concerns, and severely lower quality of life for obese individuals. To better include this condition in future public health interventions, dermatologists and primary care providers should work together to identify and manage these problems as they come up. Additionally, efforts should be made to further educate the public on the dangers of obesity-related skin issues. When problems such as acanthosis nigricans visibly manifest themselves on the outside of the body, it may be easier to demonstrate their severity and prevalence to at-risk populations.

Notes:

  1. “Obesity.” WHO, World Health Organization, www.who.int/topics/obesity/en/
  2. Prevalence of Obesity Among Adults and Youth: United States, 2011–2014.” CDC, www.cdc.gov/nchs/data/databriefs/db219.pdf+.
  3. “Overweight & Obesity.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 29 Aug. 2017, www.cdc.gov/obesity/data/adult.html.
  4. “Overweight & Obesity.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 29 Aug. 2017, www.cdc.gov/obesity/data/adult.html.
  5. Yosipovitch, Gil, et al. “Obesity and the Skin: Skin Physiology and Skin Manifestations of Obesity.” Journal of the American Academy of Dermatology, vol. 56, no. 6, 2007, pp. 901–916., doi:10.1016/j.jaad.2006.12.004
  6. “How Does Skin Work?” National Center for Biotechnology Information, U.S. National Library of Medicine, 28 July 2016, www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072439/.
  7. “Chapter 8: The Shoulder and Axilla.” Chapter 8: THE SHOULDER AND AXILLA, www.dartmouth.edu/~humananatomy/part_2/chapter_8.html
  8. NHS Choices, NHS, www.nhs.uk/conditions/acanthosis-nigricans/
  9. Hoffman, Kristine. “How Acanthosis Nigricans Can Indicate Insulin Resistance Or Diabetes.”Podiatry Today, www.podiatrytoday.com/blogged/how-acanthosis-nigricans-can-indicate-insulin-resistance-or-diabetes. 12 High concentrations of insulin stimulate the growth of darkly-colored cells, as well as small, finger-like growths on the epidermis (outermost layer of skin). 13“DermNet New Zealand.” Acanthosis Nigricans | DermNet New Zealand, www.dermnetnz.org/topics/acanthosis-nigricans/.
  10. Ng, Hak Yung. “Acanthosis Nigricans in Obese Adolescents: Prevalence, Impact, and Management Challenges.” Adolescent Health, Medicine and Therapeutics 8 (2017): 1–10. PMC. Web.
  11. “How Does Skin Work?” National Center for Biotechnology Information, U.S. National Library of Medicine, 28 July 2016, www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072439/.

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