Acanthosis nigricans is a skin disorder characterized by dark, thick, velvety skin in body folds and creases.

Acanthosis nigricans can affect otherwise healthy people, or it can be associated with medical problems. Some cases are genetically inherited. It is most common among people of African descent.

Obesity can lead to acanthosis nigricans, as can many endocrine disorders. It is frequently found in people with diabetes.

Some drugs, particularly hormones such as human growth hormone or oral contraceptives ("the pill"), can also cause acanthosis nigricans.

People with lymphoma or cancers of the gastrointestinal or genitourinary tracts can also develop severe cases of acanthosis nigricans.

Acanthosis nigricans usually appears slowly and doesn't cause any symptoms other than skin changes.

Eventually, dark, velvety skin with very visible markings and creases appears in the armpits, groin, and neck. Sometimes, the lips, palms, soles of feet, or other areas may be affected.

Your physician can usually diagnose acanthosis nigricans by simply looking at your skin. A skin biopsy may be needed in unusual cases.

If no clear cause of acanthosis nigricans is obvious, it may be necessary to search for one. Your physician may order blood tests, an endoscopy, or x-rays to eliminate the possibility of diabetes or cancer as the cause.

Because acanthosis nigricans itself usually only causes changes to the appearance of the skin, no particular treatment is needed.

It is important, however, to attempt to treat any underlying medical problem that may be causing these skin changes.

Acanthosis nigricans often fades if the cause can be found and treated.

Call your physician if you develop areas of thick, dark, velvety skin.

Morelli JG. Diseases of the epidermis. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap. 656.

Metabolic Syndrome

Metabolic syndrome is a combination of medical disorders that increase one's risk for cardiovascular disease and diabetes. It affects a large number of people in a clustered fashion. In some studies, the prevalence in the USA is calculated as being up to 25% of the population. Symptoms and features are: * Fasting hyperglycemia - diabetes mellitus type 2 or impaired fasting glucose, impaired glucose tolerance, or insulin resistance; * High blood pressure; * Central obesity (also known as visceral, male-pattern or apple-shaped adiposity), overweight with fat deposits mainly around the waist; * Decreased HDL cholesterol; * Elevated triglycerides; * Elevated uric acid levels. Associated diseases and signs are: fatty liver (especially in concurrent obesity), progressing to non-alcoholic fatty liver disease, polycystic ovarian syndrome, hemochromatosis (iron overload); and acanthosis nigricans (a skin condition featuring dark patches). [1] 1. http://en.wikipedia.org/wiki/Metabolic_syndrome

Alstrom syndrome is a very rare inherited disease that can lead to blindness, deafness, diabetes, and obesity.

Alstrom syndrome is an autosomal recessiveinherited disorder. This means that a person must inherit a copy of the defective gene from both parents to be affected. It is extremely rare, but is more common in Holland and Sweden than in the United States.

The altered gene, ALMS1, has been found. However, it is not yet known how this gene causes the disorder.

• Blindness or severe vision impairment in infancy
• Dark patches of skin (acanthosis nigricans)
• Deafness
• Impaired heart function (cardiomyopathy), which may lead to heart failure
• Obesity
• Progressive kidney failure
• Slowed growth
• Symptoms of childhood-onset or type 2 diabetes

Occasionally, the following can also occur:

• Gastrointestinal reflux
• Hypothyroidism
• Liver dysfunction
• Small penis

An eye doctor (ophthalmologist) will examine the eyes. The patient may have reduced vision.

Tests may be done to check:

• Blood sugar levels (to diagnose hyperglycemia)
• Hearing
• Heart function
• Thyroid function
• Triglyceridelevels

There is no specific treatment for this syndrome. Treatment for symptoms may include:

• Diabetes medication
• Hearing aids
• Heart medications
• Thyroid hormone replacement

Alstrom Syndrome International -- www.alstrom.org

The following are likely to develop:

• Deafness
• Permanent blindness
• Type 2 diabetes

Kidney and liver failure may get worse.

• Complications from diabetes
• Coronary artery disease (from diabetes and high cholesterol)
• Fatigue and shortness of breath (if poor heart function isn't treated)

Call your health care provider if you suspect symptoms of diabetes such as increased thirst and urination. Seek medical attention promptly if you suspect that your infant or child cannot see or hear normally.

Risk factors for Type 2 diabetes; Diabetes risk factors

You have a higher risk for diabetes if you have any of the following:

• Age greater than 45 years
• Diabetes during a previous pregnancy
• Excess body weight (especially around the waist)
• Family history of diabetes
• Given birth to a baby weighing more than 9 pounds
• HDL cholesterol under 35 mg/dL
• High blood levels of triglycerides, a type of fat molecule (250 mg/dL or more)
• High blood pressure (greater than or equal to 140/90 mmHg)
• Impaired glucose tolerance
• Low activity level (exercising less than 3 times a week)
• Metabolic syndrome
• Polycystic ovarian syndrome
• A condition called acanthosis nigricans, which causes dark, thickened skin around the neck or armpits

Persons from certain ethnic groups, including African Americans, Hispanic Americans, Asian Americans, and Native Americans, have a higher risk for diabetes.

Everyone over 45 should have a blood sugar (glucose) test at least every 3 years. Regular testing of blood sugar levels should begin at a younger age, and be performed more often if you are at higher risk for diabetes.

See: Type 2 diabetes

In the clinic. Type 2 diabetes. Ann Intern Med. 2007;146:ITC-1-ITC-15.

American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care. 2011 Jan;34 Suppl 1:S11-61.

Eisenbarth GS, Polonsky KS, Buse JB. Type 1 Diabetes Mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 31.

Pignone M, Alberts MJ, Colwell JA, Cushman M, Inzucchi SE, Mukherjee D, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statementof the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation. 2010 Jun 22;121(24):2694-701. Epub 2010 May 27.

Review Date: 06/28/2011

Ari S. Eckman, MD, Division of Endocrinology and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A growing number of youth in America are being diagnosed with type 2 diabetes, also known as non-insulin-dependent diabetes mellitus (NIDDM). In fact, it is estimated that one in three children born in the year 2000 will develop this disease. According to the American Diabetes Association (ADA), all population groups are at risk for diabetes, but it is more common in Native Americans, African Americans, Hispanics and Asian Americans/Pacific Islanders.

These are the same ethnic groups that develop a dermatological disease called acanthosis nigricans (AN). This is an important correlation, as AN is often a precursor to a diagnosable level of type 2 diabetes. Individuals can easily be screened for AN, and treatment interventions for AN are also the interventions that can prevent type 2 diabetes from manifesting altogether. Therefore, nurses and other health care professionals need to have a thorough awareness of how to identify this early indicator, who is at risk for it, its correlation with type 2 diabetes and the treatments and preventive measures for AN. Acanthosis nigricans

Acanthosis nigricans is the physical manifestation of hyperinsulinemia, or insulin resistance, in body cells.1 AN will reveal itself as dark, thick skin in areas that might be rubbed from clothing, such as the abdomen, or in skin fold regions--e.g., the groin, neck, armpits or knuckles.2For this reason, AN is also known as "black neck syndrome" in reference to the highly visible neck discoloration, which is the reaction of the epidermis to increased levels of insulin in the blood system.

The body produces insulin in order to store glucose. Cells can become resistant to the insulin hormone, especially in people who do not exercise and who have a family history of insulin resistance. This leaves the insulin locked out of cells. Beta cells in the pancreas that produce insulin begin to tire out and fail. Glucose in the bloodstream begins to increase, which leads to NIDDM. If the beta cells stop making insulin altogether, the individual could be dependent on insulin shots for the rest of his or her life.

Children will begin to show signs of AN around the age of 11.3 Most adults with AN recall it first appearing between the ages of 10 and 12. The condition is found equally in males and females.4The primary races affected by AN as a marker for type 2 diabetes are Native Americans, African Americans and Hispanics. Pacific Islanders have not been cited in the literature as having AN, but one would assume them to be at risk based on the high rate of insulin resistance in this population group.5 AN can also be seen in Caucasians, though is substantially less common.

Until recently, type 2 diabetes was thought to affect people age 40 and over. Today, type 2 diabetes in youth is on the rise, especially in ethnic minority populations. For example, the ADA reports that almost one in every two Hispanics born in the year 2000 is expected to develop the disease. This is quite alarming, as type 2 diabetes is one of the most expensive chronic illnesses in the U.S.

Luckily, AN is an early marker for the susceptibility to NIDDM. A dermatologist in Chicago states that children come in daily with AN; it is the discolored skin that brings them in.6 This highly visible "black neck" manifestation of AN is a perfect opportunity to educate these children and their families about lifestyle factors that contribute to type 2 diabetes. It is the first, early signal that the child is insulin resistant and is at risk for the cascade of detrimental effects of diabetes. AN does not mean that the individual has diabetes, although it does indicate that further testing should be done.

In the last 20 years, obesity among the general population has tripled, the ADA notes. (Obesity is defined as a body mass index, or BMI, of 30 or greater.) Obesity plays a major factor in insulin resistance. Ninety-two percent of children diagnosed as having NIDDM are obese.2 In fact, there has been such an increase in children with a BMI greater than 30 that this generation is being dubbed Generation O.

However, as a single predictor of type 2 diabetes, AN is found to be much more reliable than obesity alone.1 Researchers have found there is a five times greater risk of having high fasting insulin levels in individuals with AN versus individuals who are obese without AN.7

Before the correlation between AN and type 2 diabetes was discovered, diabetes in youth was diagnosed by chance when routine urine or blood tests were performed. AN occurs before other signs and symptoms of diabetes appear. There is a typically a seven year lapse between the beginning development of diabetes in the body and the actual diagnosis of NIDDM.2

It is important that health care providers be trained to recognize the signs of AN so that children with this dermatological marker can be tested for hyperglycemia. Screening for AN is non-threatening and non-invasive. Once AN is diagnosed, preventive measures for NIDDM can be initiated.

Screening for AN by a trained professional can be done at schools or at clinics. Typically the neck area is screened, because it has been demonstrated as showing the most consistent staging area for AN. Screening the armpits can be effective in patients with normal to below-normal weight. To help predict obesity, height, weight, hip and waist measurements can be taken along with the topical screening for AN.

Researchers grade AN into stages, but simply the appearance of AN, in any stage, indicates hyperinsulinemia and will respond to treatment. Diet and lifestyle changes alone can reduce the physical presence of AN. The dark, thickened skin will gradually disappear as insulin resistance decreases.

It is especially important that young people from the high-risk minority populations mentioned earlier be screened for AN. Screening in youth can help at-risk individuals prevent the development of type 2 diabetes later in life. Experts recommend that children be screened every two years beginning at age nine, to ensure that hyperinsulinemia is caught early and healthy lifestyle habits can be implemented successfully.6 Communities can be educated to alert friends and family to be properly screened if they notice the signs of AN on each other.

Education for patients diagnosed with AN should include two points:

1. Lifestyle and diet changes will decrease the discoloration on their skin.

2. All systems in their bodies will benefit from these changes.

Increasing patients' exercise will allow insulin into their cells and will also help glucose get out of their blood system and into their cells. This will help all of their organs operate more efficiently. Peripheral blood flow will be improved, including blood flow to the eyes. Most notably, diabetic retinopathy, which can cause blindness and sets in during early stages of NIDDM, will be improved.2

Treatment begins when the patient switches to a wholesome, well-balanced diet and starts an exercise program. Many sources, including the American Diabetes Association, recommend decreasing weight by 5-7% and exercising two-and-a-half hours a week--e.g., walking briskly. These measures can reduce an individual's risk of developing type 2 diabetes by 50%.

In conjunction with exercise and diet, in some cases oral diabetic medications may be prescribed for patients with AN. These drugs, which decrease glucose production from the liver and do not increase insulin production, include Metformin®, Actos® and Avandia®. Metformin has the added effect of metabolizing fats, which helps with weight reduction.8 Blood glucose levels should be monitored and the AN discoloration should be evaluated throughout treatment.

Adopting a healthy lifestyle will greatly enhance the individual's ability to fight off diabetes. Even if overall weight is not reduced, it is important to reduce caloric intake. This in itself will decrease cells' resistance to insulin. With exercise, the number of insulin receptors increases, improving the body's ability to use the insulin.8

Communities can help by supporting in-school and after-school programs that increase physical activity for kids. Offering activities that families can participate in together would be a great asset to the health of the community. The role of nurses and other health providers is to identify at-risk youth and educate them about healthy choices that will help them save themselves from the devastating physical effects and financial costs of diabetes.

The symptoms related to type 2 diabetes usually develop slowly over a period of time. Often there aren't any signs present when Type 2 diabetes is diagnosed. Type 2 diabetes was once thought of as an adult disease but is rapidly being seen in the younger generations.

A diabetic may have some of the symptoms or all of them. The symptoms consist of:

• Irritability
• Fatigue
• Weakness
• Little or no energy
• Slow healing of cuts, sores, or bruises
• Frequent yeast infections
• Frequent urination
• Increased thirst
• Dry mouth with or without thirst
• Weight gain
• Significant weight gain (or weight loss) can occur with type 2 diabetes
• Difficulty losing weight
• Dry skin
• Itchy skin
• Muscle aches and pains
• Muscle spasms
• Increased hunger
• Itching of the skin
• Genital itching
• Yeast infections
• Velvety dark skin changes of the neck, armpit and groin, called acanthosis nigricans
• Loss of consciousness (rare)
• Tingling or numbness of hands/fingers or feet/toes
• Unexplained weight loss
• Blurred Vision

Sometimes type 2 diabetes can go unnoticed and untreated. Occasionally, people with diabetes type 2 diabetes have no symptoms. You do not need to be overweight to develop diabetes type 2 if there is a family history of diabetes. If you suspect that you may be diabetic please consult with your physician or medical adviser as soon as possible. In some countries, such as the UK, many pharmacies offer free blood tests.

Meanwhile, if you wish to do the test yourself diabetes symptoms quiz as a preliminary measure, see the page link, further down this page, listed under Sources and Related Links.

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