Metabolic syndrome in south Indian population with skin tags: a hospital-based case control study

Background: Metabolic syndrome is a constellation of several clinical and laboratory cardiovascular risk factors that have been linked with numerous medical and dermatologic conditions. Recent evidence suggests a strong association between skin tags and insulin resistance and obesity, yet there is a paucity of data on relation of skin tags with metabolic syndrome as a whole. Aim of the study was to evaluate the strength of association between skin tags and metabolic syndrome.Methods: 70 patients with skin tags and an equal number of age and gender matched controls were enrolled in a hospital-based case control study. Anthropometric measures, blood pressure, fasting glucose, high density lipoprotein cholesterol and triglycerides were measured. Metabolic syndrome was diagnosed by the presence of 3 or more of the south Asian modified national cholesterol education program’s adult panel III criteria. Statistical analysis was performed using chi square test, and odds ratio was calculated. P≤0.05 were considered significant.Results: Metabolic syndrome was significantly more common in patients with skin tags than in controls (70% vs. 26%, p<0.001). Triglycerides and waist circumference values were significantly increased in cases as compared to controls (p<0.05).  There was no statistically significant difference in the high-density lipoprotein levels, fasting blood glucose levels and presence of hypertension among cases and controls.Conclusion: Skin tags when present in multiple could be an early warning sign for Metabolic syndrome. They serve a cutaneous marker to initiate early detection and intervention of at-risk patients for cardiovascular disorders.

Anterior segment dysgenesis and secondary glaucoma in Goldenhar syndrome

A 3-year-old girl presented with a history of watering, haze and increase in the size of the right eye for two months. The child had bilateral preauricular skin tags, limbal dermoid and dermolipoma, consistant with the diagnosis of Goldenhad syndrome. In addition, her right eye manifested enlarged cornea, flat anterior chamber, atrophic iris and elevated intraocular pressure. This case report highlights a possible association of anterior segment dysgenesis and glaucoma with Goldenhar syndrome.

Multiple soft fibromas of the lid.

Fibromas are benign tumors that are composed of fibrous or connective tissue. They can grow in all organs, arising from mesenchymal tissue (a type of loose connective tissue). The term “fibroblastic” or “fibromatous” is used to describe tumors like the fibroma. This 69‑year‑old male presented to us with giant, multiple, very slowly progressive, painless, noninflammatory, soft, trans‑illuminant, pedunculated lid swellings with a two decade history. There were no other swellings on the body. He was clinically normal on systemic examination except for the immature cataracts in both eyes. The diagnosis was confirmed on histopathology. Simple excision removed all the soft fibromas virtually leaving no scar. A review of literature world‑wide using Medline Plus/PubMed revealed this to be the only reported case of multiple giant soft fibromas of the lid.

Skin tags, leptin, metabolic syndrome and change of the life style.

Background: Skin tags (STs), are papillomas commonly found in the neck and in the axillae of middle-aged and elderly people. Metabolic syndrome (MS) is a complex of interrelated risk factors for cardiovascular disease and diabetes. Epidemiologic studies of different ethnic populations have indicated that hyperleptinaemia and leptin resistance are strongly associated with MS. Aim: To study the possible relation of skin tags and leptin levels to MS guided by the International Diabetes Federation (IDF) diagnostic criteria. Methods: This study included 80 participants, 40 ST patients and 40 apparently healthy controls. Age, sex, waist circumference (WC), body mass index (BMI), smoking status, fasting glucose level, insulin level and insulin resistance were estimated as well as cholesterol, triglycerides, HDL, criteria of MS, and leptin levels. Results: The univariate analysis showed that WC, BMI, fasting glucose, insulin levels, insulin resistance, cholesterol, triglycerides, HDL, and leptin levels were significantly higher in ST patients compared to controls (P < 0.001). The multivariate analysis between MS components and ST showed that only high triglyceride levels (OR 1.205/95% CI 1.044-1.391/P = 0.011) and low HDL levels (OR 0.554/95% CI 0.384-0.800/P = 0.002) were significantly associated with ST. Multivariate linear regression analysis of the predictors of high plasma leptin levels, showed that high triglyceride levels (OR 0.287/95% CI 0.410-3.56/P = 0.014), and low HDL levels (OR -0.404/95% CI -8.7 to -2.08/P = 0.002) were significant predictors. Conclusion: The results of this study suggested that the presence of both ST and hyperleptinaemia in patients with STs may be associated with high levels of triglycerides and low levels of HDL and this could suggest that changing the life style of patients with ST may have a beneficial role.

Increased tissue leptin hormone level and mast cell count in skin tags: A possible role of adipoimmune in the growth of benign skin growths.

Background: Skin tags (ST) are common tumors. They mainly consist of loose fibrous tissue and occur on the neck and major flexures as small, soft, pedunculated protrusions. Decrease in endocrine, hormone level and other factors are thought to play a role in the evolution of ST. Leptin is an adipocyte-derived hormone that acts as a major regulatory hormone for food intake and energy homeostasis. Leptin deficiency or resistance can result in profound obesity and diabetes in humans. A role of mast cell in the pathogenesis of ST is well recognized. Aims: To investigate the role of leptin in the pathogenesis of ST and to clarify whether there is a correlation between mast cell count and leptin level in ST. Methods: Forty-five skin biopsies were taken from 15 patients with ST. From each patient, a biopsy of a large ST (length >4 mm), a small ST (length <2 mm) and a normal skin biopsy (as a control) were taken. The samples were processed for leptin level. Skin biopsies were stained with hematoxylin and eosin and toluidine blue-uranyl nitrate metachromatic method for mast cell count was used. Results: There was a significant increased level of leptin in the ST compared to the normal skin. It was highly significant in small ST than in big ST (P = 0.0001) and it was highly significant in small and big ST compared to controls, P = 0.0001 and P = 0.001, respectively. There was a significant increase in mast cell count in the ST, which did not correlate with the increased levels of leptin. Conclusion: This is the first report to demonstrate that tissue leptin may play a role in the pathogenesis of ST. The significant increase in the levels of leptin and mast cell count in ST may indicate a possible role of adipoimmune in the benign skin growths.

High prevalence of thyroid nodules in patients with achrocordons (skin tags): Possible role of insulin-resistance / Alta prevalencia de nódulos tiroideos en pacientes con acrocordones (fibromas blandos): Posible papel de la insulino-resistencia

Due to the observation of a great number of patients having achrocordons, when they underwent fine needle biopsies for thyroid nodules, we decided to perform a prospective study to investigate the relationship between this finding and the presence of insulin resistance (IR), since achrocordons are commonly seen in hyperinsulinemic subjects. A total of 120 consecutive women, aged 18-35 yrs were studied. All subjects were also evaluated by thyroid ultrasound (US) for measuring thyroid volume and the presence of nonpalpable nodules. Basal and post-prandial serum insulin was measured in all of them, as well as the Homeostasis Model Assessment (HOMA). Subjects were divided in two groups: Group A, with achrocordons (n = 44) and Group B, without achrocordons (n = 76). Group A showed 24 patients (54.5%) with thyroid nodules, whereas Group B only 13 subjects (17.1%); p = 0.0087. When we considered, as having high normal thyroid volume, the glands weighting more than 16 grams by US, without nodules, it was found that 8/44 cases from Group A (18.6%) and 3/76 from Group B (3.9%) fitted in such category, p = 0.0076. In patients with nodules and/or bigger thyroids, IR was observed in 36/44 (81.8%) of Group A and 14/76 (18.4%) of Group B, p = 0.0069, while the overall prevalence of IR was 0.47 in Group A and 0.05 in Group B, p = 0.00094. It is concluded that patients with achrocordons have a higher prevalence of US-detected thyroid nodules and larger thyroid glands. Then, it may be beneficial to search for thyroid abnormalities in those subjects with skin tags.

Debido a la alta frecuencia de acrocordones en pacientes que concurrían a nuestro servicio para realizar punciones aspirativas de nódulos tiroideos, realizamos un estudio prospectivo para investigar la relación entre este hallazgo y la presencia de insulino resistencia (IR), dado que los acrocordones son frecuentemente observados en pacientes hiperinsulinémicos. Se incluyeron 120 pacientes consecutivas, con edades entre 18 y 35 años. Todas fueron evaluadas con una ecografía tiroidea para determinar su volumen y la presencia de nódulos no palpables. Se midió insulinemia basal y post prandial, así como el índice Homeostasis Model Assessment (HOMA). Las pacientes se dividieron en 2 grupos: Grupo A, con acrocordones (n = 44) y Grupo B, sin acrocordones (n = 76). En el Grupo A se encontraron 24 (54.5%) con nódulos tiroideos, mientras que el Grupo B, sólo 13 (17.1%); p = 0.0087. Cuando consideramos la presencia de una glándula tiroides de tamaño elevado pero dentro de los límites normales, medida por ecografía (peso mayor a 16 gramos sin nódulos), encontramos que 8/44 casos del Grupo A (18.6%) y 3/76 del Grupo B (3.9%) entraron en esta categoría, p = 0.0076. En aquellas pacientes con nódulos tiroideos o glándula tiroides de mayor tamaño, observamos IR en 36/44 (81.8%) del Grupo A y en 14/76 (18.4%) del Grupo B, p = 0.0069, mientras que la prevalencia total de IR fue del 0.47 en el Grupo A y del 0.05 en el Grupo B, p = 0.00094. En conclusión, las pacientes con acrocordones tuvieron mayor prevalencia de nódulos tiroideos detectados por ecografía, glándula tiroides de mayor tamaño y mayor proporción de insulino resistencia.

The Clinical Features of Skin Tags and the Association Between Skin Tags and Colonic Polyps / 대한피부과학회지

BACKGROUND: Skin tags are benign fleshy or darker colored papillomatous dermal tumors locatei mostly in the neck, axill or groin. Recent reports on a possible association between skin tags and colonic polyps, however, caused interest in these henign tumors of the dermis, especially wite regarding to their frequercy. OBJECTIVE: The purpose rate this study was to explore the clinical profiles of skin tags, the effect of obesity on the frequeny of skin tags and the association between skin tags and obesity in the normal population. We also tried to evaluate the usefulness of skin tags as a general marker for the presence of colonic piyps. METHODS: The first, 524 unselected patients were examined. The patient material comprised of 240 males and 284 females. Each patient was inspected with regard to skin tags by a clermatolgist. 334 patients were classified into obese groups and nonobese groups and then we evaluated the relationship between skin tags and the degree of obesity. The second, ninety consecutive patients referred for coloniscopic evaluation were examined to determine the association between skin tags and colonic polps. RESULTS: We found 22.9% of the males and 22.5% of the females to be skin tag carriers in the general population. We also noticed a steady increase of the frequency according to age eccept for the third decads. Of the skin tags found 51% were in the axillar region, 40% around the neck and 8% in the inguinal region. In the study for the relationship between skin tags and obesity, 44.9% of the obise patients and 23% of the nonobese patients were skin tag carriers(relative risk=1.95, p<0.05). In the study for the association between skin tags and colonic polyps in patients undergoing colonoscopic examination, 18 of patients with skin tags(45%) hnd colonic polyps and 11 of patients without skin tags(22%) had colonic polyps(relative risk=2.05, p<0.05). CONCLUSION: This study identified an obese group that are at risk of the developing skin tags. Consideration of skin tags as a marker for colonic polyps is likely to prove helpful.

TCA chemical peeling / 대한피부과학회지

Tricholroacetic acid (TCA) chemical peeling is an effective, versatle and safe therapeutic method for patients with pigmentary disorders, acne scars and aging skin. With an experienced and skilled operator, the associated complications are rare and tend to be mild. No. ystemic toxicity is known to be induced by TCA. We observed the effect of TCA chemical peeling, evaluated by 242 patients themselves with melasma, freckles, senile lentgines, pigmented nevi, seborrheic keratosis, skin tags or acne scars. The patients evaluated TCA peeling as excellent for the treatment of seboirheic keratosis, pigmented nevi, skin tags and acne scars, and as selectively recommendable for the treatment of melasma, freckles and senile lentigines.