Dermatologic Manifestations of Obesity - Part 2 Endocrine Abnormalities

Review Article

Austin J Dermatolog. 2016; 3(3): 1053.

Dermatologic Manifestations of Obesity - Part 2 Endocrine Abnormalities

Reid A Waldman¹* and Anne H Kettler²

¹UMKC School of Medicine, UMKC Vision Research Center, USA

²Department of Dermatology, College Park Family Care Center, USA

*Corresponding author: Reid Alexander Waldman, Fifth Year Medical Student, UMKC School of Medicine, UMKC Vision Research Center, Shawnee Mission, KS, Kansas City, Missouri, USA

Received: July 07, 2015; Accepted: May 19, 2016; Published: May 21, 2016


Over the past several decades, the proportion of Americans suffering from obesity has risen drastically. Accompanying this increase in obesity is a concomitant increase in many of the co-morbidities associated with obesity, many of which are seen less frequently in persons with normal body weight. Notably, there has been an increase in dermatologic conditions seen in this special patient population. The skin maladies seen with increased frequency in obese patients are caused by a variety of factors, specifically: (1) the mechanical changes associated with increased weight; (2) the hyperandrogenism of obesity; and (3) the secondary hyperinsulinemia of obesity. Endocrine abnormalities that often accompany obesity and the resultant common dermatologic conditions associated with these abnormalities include acrochordons, acanthosis nigricans, keratosis pilaris, hidradenitis suppurativa, acne keloidalisnuchae, hirsutism, and hypothyroidism.

Keywords: Obesity; Acrochordons; Hyperandrogenism; Hyperinsulinemia; Acanthosis nigricans; Keratosis pilaris; Hidradenitis suppurativa; Acne keloidalisnuchae; Hirsutism; Hypothyroidism


This two-part series of articles will review clinical dermatologic manifestations of obesity, identify clinical findings that can serve as harbingers of more serious systemic disease, help direct treatment choices, and ultimately improve patient care outcomes. Part 1 examined the relationship between the mechanical changes caused by obesity and the resultant common dermatologic conditions associated with the changes. [2] Part 2 will explore the relationship between the endocrine abnormalities that often accompany obesity and the resultant common dermatologic conditions associated with these abnormalities.

Acrochordons (Skin Tags)

Acrochordons, known to lay people as skin tags, are brown or flesh-colored soft papules attached by a stalk which occur in 25% of the general population [2]. There is an increased incidence in both the number and density of acrochordons in the obese with a linear correlation existing between increasing BMI and an increase in the presence and density of acrochordons. Most commonly, acrochordons occur on the face, eyelid, neck, axilla, and groin; however, acrochordons occurring on the extremities, vulva, and a variety of other locations have been reported [3]. The primary complaint of the obese patient with acrochordons is cosmetic although some patients note that the lesions can become painful and irritated secondary to the patient’ clothing or jewelry repeatedly rubbing against them. Whereas non-obese patients are likely to only have several acrochordons, obese patients often have large, dense, groupings of the lesions. Although the clinical diagnosis of acrochordons is relatively straightforward, several other skin lesions including basal cell carcinomas and an accessory auricular tragus may mimic acrochordons. When there is a question regarding the correct diagnosis, biopsy of the lesion should be considered. Histologically, the stalk of acrochordons will reveal numerous dilated capillaries, as well as the presence of varied loose connective tissue [4]. The epidermis of the acrochordons characteristically has a combination of benign appearing acanthosis, hyperkeratosis, and papillomatosis [4]. While acrochordons are usually benign and in general their presence is not a harbinger of more serious underlying conditions, acrochordons can occasionally be associated with serious underlying conditions and therefore it is important to keep these associated diseases in mind. This is especially true when encountering the obese patient presenting with the sudden and rapid development of multiple acrochordons. One condition associated with the rapid development of multiple acrochordons is Gardner Syndrome. Gardner syndrome is a potentially fatal, heritable condition which is a subtype of familial colorectal polyposis. Patients suffering from Garner Syndrome exhibit gastrointestinal adenocarcinomatous polyps, osteoma of the skull and jaw, epidermoid cysts, retinal abnormalities, desmoid tumors of the breast and chest wall, thyroid tumors, abnormalities of dentition, and acrochordons (Table 1).