Skin Disorders in Overweight and Obese Patients and Their Relationship With Insulin

IntroductionThe prevalence of obesity has increased worldwide in recent years. Some authors have described skin conditions associated with obesity, but there is little evidence on the association between insulin levels and such disorders.ObjectiveTo describe the skin disorders present in overweight and obese patients and analyze their association with insulin levels.Material and methodsThe study included nondiabetic male and female patients over 6 years of age who were seen at our hospital between January and April 2011. All the patients were evaluated by a dermatologist, who performed a physical examination, including anthropometry, and reviewed their medical history and medication record; fasting blood glucose and insulin were also measured. The patients were grouped according to degree of overweight or obesity and the data were compared using analysis of variance or the χ2 test depending on the type of variable. The independence of the associations was assessed using regression analysis.ResultsIn total, 109 patients (95 adults and 13 children, 83.5% female) were studied. The mean (SD) age was 38 (14) years and the mean body mass index was 39.6 ± 8 kg/m2. The skin conditions observed were acanthosis nigricans (AN) (in 97% of patients), skin tags (77%), keratosis pilaris (42%), and plantar hyperkeratosis (38%). Statistically significant associations were found between degree of obesity and AN (P = .003), skin tags (P = .001), and plantar hyperkeratosis. Number of skin tags, AN neck severity score, and AN distribution were significantly and independently associated with insulin levels.ConclusionsAN and skin tags should be considered clinical markers of hyperinsulinemia in nondiabetic, obese patients.

ResumenIntroducciónLa prevalencia de obesidad se ha incrementado mundialmente en los últimos años. Existen estudios que describen las dermatosis que se asocian con la obesidad; sin embargo, existe poca evidencia de su asociación con los niveles de insulina.ObjetivoDescribir las dermatosis presentes en pacientes con sobrepeso y obesidad y su asociación con los niveles de insulina.Material y métodosSe incluyeron pacientes de ambos sexos, mayores de 6 años, no diabéticos que acudieron a la consulta durante los meses de enero a abril de 2011. Todos los sujetos fueron valorados por un dermatólogo, se realizó exploración física, antropometría, historia médica, medicamentos y medición de glucosa e insulina de ayuno. Los pacientes se dividieron de acuerdo a sobrepeso y grado de obesidad y se compararon con Anova o Chi cuadrado, dependiendo del tipo de variable. Se realizó análisis de regresión para evaluar la independencia de las asociaciones.ResultadosFueron incluidos 109 pacientes (95 adultos y 13 niños; 83,5% mujeres), con edad media de 38 ± 14 años y un índice de masa corporal de 39,6 ± 8 kg/m2. Las dermatosis encontradas fueron: acantosis nigricans (97%), fibromas (77%), queratosis pilar (42%) e hiperqueratosis plantar (38%). Las que se asociaron de forma estadísticamente significativa con el grado de obesidad fueron acantosis nigricans (p = 0,003), fibromas (p = 0,001) e hiperqueratosis plantar. El grado de acantosis nigricans en el cuello, su topografía y el número de fibromas mostraron asociación significativa e independiente con los niveles de insulina.ConclusionesLa acantosis y los fibromas deberían considerarse marcadores clínicos de hiperinsulinemia en población obesa y no diabética.