An Indian Expert Group Review of Acanthosis Nigricans with Recommendations for Early Detection and Timely Management.

INTRODUCTION: Acanthosis nigricans (AN) is a visible cutaneous manifestation of several underlying systemic conditions, such as prediabetes, diabetes mellitus (DM), polycystic ovarian syndrome (PCOS), metabolic syndrome (MS), and malignancy. AN is commonly seen in obese individuals and is a proven skin marker of insulin resistance (IR). Its typical clinical presentation and location, especially on the nape of the neck, allows for easy visual identification. Obesity, IR, and other noncommunicable diseases (NCD) are on the rise in India, with many cases being undiagnosed or missed. Every sixth diabetic in the world is Indian. AN can thus play a vital role in screening, early identification, and reduction of morbidity, especially of IR-related disorders. Currently, there are no national or international multidisciplinary guidelines or recommendations for AN. OBJECTIVE: To review published current literature and evidence on AN, its associations, and management. To recommend an approach to clinical identification of AN, associated/underlying disorders, investigations, and management, including lifestyle modifications. To sensitize and familiarize clinicians and healthcare workers across India with AN presentations. This will enable early detection of conditions such as IR, prediabetes, DM, PCOS, malignancy, etc., in practice and in the community. MATERIALS AND METHODS: The PCOS Society of India constituted a multispecialty Expert Working Group with representation from various national societies to review all published scientific evidence. Expert group meetings were conducted to provide recommendations. CONCLUSION: Acanthosis nigricans is a simple, non-invasive, cost-effective screening tool for early identification of IR. It is important to integrate and disseminate information and training on AN across medical specialties. The government of India has launched several National Health Programmes to help address the rising burden of NCD in the population. AN would provide a simple screening tool to pick up undiagnosed or missed cases.

Skin cleansing in neonates and infants--basics of cleansers.

OBJECTIVE: Using a proper cleanser for bathing neonatal and infant skin is of prime importance considering the anatomical differences with regard to adult skin. Choosing the right cleanser requires knowledge of the composition of a cleanser as well as the properties of the individual ingredients. METHODS: The article discusses the guidelines for cleansing the skin of neonates and infants. The characteristics of an ideal cleanser for pediatric skin have also been enumerated. RESULTS: In India, majority of cleansers recommended for babies do not mention their active ingredients. Their claims of "mildness" have not been substantiated with clinical studies. Cetaphil, a non-soap, lipid-free liquid cleanser, has been clinically proven to be non-irritating by the Chamber Scarification Test. Moreover, Cetaphil also has a pH of less than 7, which does not alter the physiological pH of skin. CONCLUSION: Hence, Cetaphil should definitely be considered while choosing a cleanser for neonates and infants.