Tripe palms and acanthosis Nigricans: A clue for diagnosis of advanced pancreatic adenocarcinoma

Barman, Bhupen; Devi, L Purnima; Thakur, Binod Kumar; Raphael, Vandana

doi:10.4103/idoj.idoj_427_18

Cited by 11 publications

(4 citation statements)

References 8 publications

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“…Usually, AN becomes the only clue for a hidden malignancy, and the oral region is usually involved [ 181 , 182 ]. Although the dermatological lesion itself does not display a malignant profile, it behaves similar to a paraneoplastic syndrome [ 183 , 184 , 185 ].…”

Section: Discussionmentioning

confidence: 99%

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Acanthosis Nigricans: Pointer of Endocrine Entities

et al. 2022

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Acanthosis nigricans (AN) has been reported in relation to insulin resistance (IR). We aim to review AN through an endocrine and metabolic perspective focusing on IR in association with metabolic complications such as obesity, diabetes mellitus (DM), and metabolic syndrome (MS) with/without polycystic ovary syndrome (PCOS). We revised English papers on PubMed covering publications from the last 5 years. The current prevalence of AN varies from 4.5 to 74% (or even 100%, depending on the studied population), with equal distribution among females and males. Despite higher incidence with an age-dependent pattern, an alarming escalation of cases has been noted for obesity and MS in younger populations . Most frequent IR-associated sites are the neck, axilla, and knuckles, but unusual locations such as the face have also been reported. Quantitative scales such as Burke have been used to describe the severity of the dermatosis, particularly in correlation with IR elements. Dermoscopic examination are required, for instance, in cases with sulcus cutis, hyperpigmented spots, crista cutis, and papillary projections. A skin biopsy may be necessary, but it is not the rule. Both IR that clinically manifests with or without obesity/MS correlates with AN; most studies are cross-sectional, with only a few longitudinal. The approach varied from screening during school periodic checkups/protocols/programs to subgroups of individuals who were already known to be at high cardio-metabolic risk. AN was associated with type2DM, as well as type 1DM. Females with PCOS may already display metabolic complications in 60–80% of cases, with AN belonging to the associated skin spectrum. AN management depends on underlying conditions, and specific dermatological therapy is not generally required, unless the patient achieves metabolic control, has severe skin lesions, or desires cosmetic improvement. In IR cases, lifestyle interventions can help, including weight control up to bariatric surgery. In addition, metformin is a key player in the field of oral medication against DM type 2, a drug whose indication is extended to PCOS and even to AN itself, outside the specific panel of glucose anomalies. In terms of cosmetic intervention, limited data have been published on melatonin, urea cream, topical retinoids, vitamin D analogs, or alexandrite laser. In conclusion, awareness of IR and its associated clinical features is essential to provide prompt recognition of underlying conditions. AN represents a useful non-invasive surrogate marker of this spectrum in both children and adults. The pivotal role of this dermatosis could massively improve endocrine and metabolic assessments.

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Section: Discussionmentioning

confidence: 99%

“…Wollina U. et al introduced the idea that AN is like a “two-sided coin”, being either related to IR-MS or malignancies [ 183 , 184 , 185 , 186 ]. A patient with AN may experience this skin lesion while appearing asymptomatic or already under surveillance for IR-related components.…”

Section: Discussionmentioning

confidence: 99%

Acanthosis Nigricans: Pointer of Endocrine Entities

et al. 2022

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“…Metabolic syndrome is associated with secretion of a number of factors, such as insulin-like growth factor (IGF), epidermal growth factor (EGF), and fibroblast growth factor (FGF), leading to fibroblast proliferation and keratinocyte formation [23][24][25] . In patients with pancreatic carcinoma and acanthosis nigricans, a clinical symptom is pruritus, accompanied by cutaneous or even mucosal papillomatosis 26 .…”

Section: Acanthosis Nigricansmentioning

confidence: 99%

Skin manifestations of pancreatic diseases

Kunovský¹,

Dítě²,

Březinová³

et al. 2022

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Although symptoms of pancreatic diseases such as pancreatitis, acute and chronic and, carcinoma of the pancreas are mainly gastrointestinal in nature, the extra-pancreatic symptoms are also important. These include skin symptoms, such as pancreatic panniculitis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema, cutaneous signs of hemorrhage, as in persons with severe acute pancreatitis, or the finding of cutaneous metastases of pancreatic carcinoma, which may be a sign of advanced disease. The pancreas is therefore one of those organs for which diagnosis and therapy are often multidisciplinary. In this review article, we summarize current knowledge of the possible skin manifestations of pancreatic disorders.

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“…In patients with gastrointestinal adenocarcinomas (stomach most commonly but pancreas also), AN often manifests with pruritus, and sometimes even with cutaneous/mucosal papillomatosis [ 44 , 45 ]. Clinical examination can reveal other associated paraneoplastic dermatosis such as tripe palms or eruptive seborrheic keratoses—the Leser–Trélat sign [ 46 ].…”

Section: Cutaneous Manifestations In Pancreatic Diseasesmentioning

confidence: 99%

Cutaneous Manifestations in Pancreatic Diseases—A Review

Miulescu

Balaban

Şandru

et al. 2020

JCM

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Pancreatic pathology, comprising acute and chronic pancreatitis, autoimmune pancreatitis and pancreatic neoplasms, primarily presents with gastrointestinal symptoms and signs; however, it is well recognized that it can also associate a wide range of extra-digestive features. Among these systemic manifestations, cutaneous involvement plays an important role both as a diagnostic clue for the pancreatic disease itself and serving as a prognostic factor for the severity of the condition. Recognition of these cutaneous signs is, however, far from being satisfactory, all the more as some of them are relatively rare. In the current review, we discuss skin involvement in pancreatic diseases, referring to pancreatic panniculitis, cutaneous hemorrhagic manifestations, skin metastasis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema and cutaneous fistula. We highlight the clinical characteristics, treatment and prognostic value of these lesions. Better awareness among medical specialties other than dermatology is needed for detection of the skin clues associated with pancreatic pathology.

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Tripe palms and acanthosis Nigricans: A clue for diagnosis of advanced pancreatic adenocarcinoma

Cited by 11 publications

References 8 publications

Acanthosis Nigricans: Pointer of Endocrine Entities

Acanthosis Nigricans: Pointer of Endocrine Entities

Skin manifestations of pancreatic diseases

Cutaneous Manifestations in Pancreatic Diseases—A Review

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