Acanthosis Nigricans - A reliable diagnostic indicator of insulin resistance and type 2 Diabetes Mellitus in obese youth and adolescents




Shah, Taksh
Barve, Amruta
Kolluru, Samyuktha
Rich, Alisa


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Background: Over the last few decades, there has been an increasing prevalence of Type 2 diabetes mellitus (DM) in youth with obesity. Acanthosis Nigricans (AN) is frequently associated with obesity and is a reliable risk indicator for developing type 2 diabetes. Although the risk for obesity is elevated in African American populations in general, there is a 2-fold increased risk in African Americans having AN to develop non-insulin dependent diabetes mellitus (NIDDM). AN once considered a rare dermatological condition is now frequently observed among obese youths and adolescents across ethnicities. Objective: The aim of this study is to evaluate AN as a diagnostic indicator; and its correlation to insulin resistance, obesity, and increased risk for development of diabetes in obese youth and adolescents. Methods: A systematic review of databases (Pubmed, Scopus, and Medline) resulted in 1743 publications related to AN, and Type 2 DM. Cross referencing AN, and Type 2 DM with obesity resulted in 679 publications since 2000. Search was narrowed using keywords AN, type 2 DM, insulin resistance, obesity, risk, youth and screening which resulted in 27 referenced papers. Abstracts of the papers were retrieved and reviewed for relevance resulting in 22 papers retrieved in full and evaluated. Studies, where AN presents with drug induced, autoimmune (systemic lupus erythematosus) or syndromic (hyperandrogenism) conditions, were excluded. Results: Results of the study confirm AN is associated with insulin resistance in obese youth and adolescents. Reports indicate a strong association of AN with insulin resistance, hyperinsulinemia, and risk for developing diabetes. Hyperpigmentation of the skin in AN is generally symmetrically distributed in the neck area, but can also be present in the forehead and folds of the skin (groin, armpits, and bends of the arms and knees). Research confirmed a positive and independent association between ethnicity, family history of diabetes, high body mass index (BMI), obesity, hyperinsulinemia, insulin resistance and AN. Conclusions: AN is strongly associated with obesity, hyperinsulinemia, insulin resistance and type 2 DM, which can be used as a reliable index for insulin resistance and to identify diabetes risk. It provides a valuable tool to primary care providers for prediabetes identification and secondary prevention. Screening programs for AN can be conducted in schools to identify children at the highest risk of developing type 2 DM associated with obesity. Intervention programs should incorporate AN screening, an easily performed and noninvasive technique along with other important risk factors for identifying obese adolescents at risk for type 2 diabetes. Adopting lifestyle changes along with early detection of AN and other risk markers may reduce the prevalence, incidence, and burden of type 2 DM in obese youth and adolescents.