Which cutaneous manifestations occur in other endocrine and metabolic disorders that are related to DM

Acanthosis nigricans is characterized by hyperpigmentation of the skin in regions where this forms folds, as in the axillae, the neck and the groins (Figure 18.4). Generalized acanthosis nigricans is usually related to development of neoplasia, mainly of the gastrointestinal tract, whereas the more limited form is related to conditions of insulin resistance, such as obesity, Type 2 DM, the polycystic ovary syndrome and acromegaly.

Eruptive xanthomata are due to deposits of triglycerides in the skin and are more frequent in diabetic men with hypetriglyceridaemia and poor metabolic control of DM. They present as small, red or yellow nodules, up to 0.5 cm in diameter, on the extensor surfaces of the extremities and the buttocks (Figure 18.5). Their occurrence is usually abrupt and they disappear slowly with the improvement of hypetriglyceridaemia.

Figure 18.4. Acanthosis nigricans of the axilla.
Figure 18.5. Xanthomata on the buttocks. (Reprinted from Textbook of Diabetes, 3rd edn., J. Pickup & G. Williams, Copyright 2003, with permission from Blackwell Science Ltd.)

Vitiligo is also more frequent in diabetic individuals (mainly with Type 1 DM). It is due to an autoimmune destruction of the skin melanocytes and presents as symmetrical, usually, white (because of discoloration), patches of skin.

Other endocrine conditions that cause cutaneous manifestations and are related to the appearance of DM are glucagonoma (causes the characteristic migratory necrolytic erythema), haemochromatosis (dark pigmentation of the skin), Cushing syndrome (atrophy of skin, striae in the abdomen, hirsutism), acromegaly (thickness of skin), the polycystic ovary syndrome (hirsutism, acanthosis nigricans) and the lipodystrophy syndromes.

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