Kamile Demirci, Nilgün Bilen, Aysun Şikar Aktürk, Evren Odyakmaz Demirsoy, Zeynep Cantürk, Çiğdem Çağlayan, Dilek Bayramgüler, Rebiay Kıran

Erişkin Obez Hastalarda Dermatolojik Bulgular

Amaç: Obez hastalardaki dermatolojik bulgularla ilişkili olarak literatürde çok az sayıda çalışma bulunmaktadır. Bu nedenle çalışmamızda obez hastalardaki deri bulgularını ve bunların yaş, menapoz, gebelik sayısı ve insülin direnci ile ilişkilerinin araştırması amaçlanmıştır.Gereç ve Yöntemler: Bu çalışma vücut kitle indeksi 30 kg/m2nin üzerinde olan 119 hastayı ve kontrol grubu olarak normal kiloya sahip 122 bireyi kapsamaktadır. Dematozların görülme sıklıkları iki grup arasında karşılaştırılmıştır.Bulgular: Her iki grupta da en sık rastlanan dermatolojik bulgu stria idi. Ancak iki grup arasında istatistiksel anlamlı bir farklılık yoktu. Plantar hiperkeratoz çalışma ve kontrol gruplarında sırasıyla % 47,1 ve % 7,4 oranlarında bulundu ve farklılık istatistiksel olarak anlamlıydı. Aynı zamanda akrokordon, akantozis nigrikans, keratozis pilaris ve intertrigo sıklığı obez grupta anlamlı olarak yüksekti. Variköz venler kontrol grubunda (% 36,9) obez grup (% 31,9) ile karşılaştırıldığında daha sık gözlendi. Çalışma grubunda insülin direnci olan ve olmayan olgular plantar hiperkeratoz, intertrigo, keratozis pilaris, variköz venler, stria, akrokordon ve kserosis görülme sıklıklarına göre karşılaştırıldığında istatistiksel olarak anlamlı bir farklılık yoktu. Ancak akantozis nigrikans olan 14 olgunun 13’ünde insülin direnci olması çarpıcı bir bulguydu.Sonuç: Çalışmamız göstermiştir ki bazı dermatolojik bulgular obez hastalarda daha sıktır. Dolayısıyla obezitenin önlenmesi bu dermatozların da önlenmesini sağlayacaktır.

Anahtar Kelimeler:

Obezite, deri bulguları, insülin direnci

Dermatologic Findings In Adult Obese Patients

Objectives: There are only a few studies about the dermatological findings of obese patients in the literature. However, we aimed to investigate the dermatological findings of obese patients and the relationship of these conditions with age, menopause, number of pregnancies, and insulin resistance in our study.Material and Methods: This study included 119 patients with a body mass index higher than 30 kg/m2 and 122 normal weight individuals as a control group. Also, the insulin resistance was calculated of the patients. The prevalences of dermatoses were compared between the two groups.Results: The most common dermatologic finding in both groups was striae. But, there was not statistically significant difference between two groups. Plantar hyperkeratosis was found in 47.1% and 7.4% of patients in the study and control groups, respectively and the difference was statistically significant. Also the frequencies of acrochordon, acanthosis nigricans, keratosis pilaris and intertrigo were significantly higher in the obese group. Varicose veins were more common in the control group (36.9%) compared with the obese group (31.9%). There was no statistically significant difference between the patients with and without insulin resistance in terms of frequency of plantar hyperkeratosis, intertrigo, keratosis pilaris, varicose veins, striae, acrochordon and xerosis in the obese group. However, it was striking that there was insulin resistance in 13 of the 14 patients who had acanthosis nigricans.Conclusions: Our study showed that some dermatological findings were significantly more common in obese patients. So, prevention of obesity is important in terms of prevention of these dermatoses.

Keywords:

Obesity, skin manifestations, insulin resistance,

PDF

___

Yosipovitch G, De Vore A, Dawn A. Obesity and the skin: Skin physiology and skin manifestations of obesity. J Am Acad Dermatol. 2007; 56: 901-16.
Scheinfeld NS. Obesity and dermatology. Clin Dermatol. 2004; 22: 303-309.
Hahler B. An overview of dermatological conditions commonly associated with the patient with obesity. Ostomy Wound Manage. 2006; 52: 34-46.
Garcia Hidalgo L. Dermatological complications of obesity. Am J Clin Dermatol. 2002; 3: 497-506.
Van Dijk L, Otters HB, Schuit AJ. Moderately overweight and obese patients in general practice: a population based survey. BMC Fam Pract. 2006; 7: 43.
Orzano AJ, Scott JG. Diagnosis and treatment of obesity in adults: an applied evidence-based review. J Am Board Fam Pract. 2004; 7: 359- 369.
Singh G, Kumar LP. Striae distensae. Indian J Dermatol Venereol Leprol. 2005; 71: 370- 372.
Watson RE, Parry EJ, Humphries JD, et al. Fibrillin microfibrils are reduced in skin exhibiting striae distensae. Br J Dermatol. 1998; 138: 931- 937.
Stott JR, Hutton WC, Stokes IA. Forces under the foot. J Bone Joint Surg Br. 1973; 55: 335- 344.
Garcia-Hidalgo L, Orozco-Topete R, Gonzalez-Barranco J, et al. Dermatoses in 156 obese adults. Obes Res. 1999; 7: 299–302.
Hills AP, Hennig EM, McDonald M, Bar-Or O. Plantar pressure differences between obese and non-obese adults: a biomechanical analysis. Int J Obes Relat Metab Disord. 2001; 25: 1674-1679.
Odom RB, James WD, Berger TG. Seborrheic dermatitis, psoriasis, recalcitrant palmoplantar eruptions, pustular dermatitis and erythroderma. Andrews' diseases of the skin, clinical dermatology. 9th ed. Odom RB, James WD, Berger TG, editors. Philadelphia. W.B. Saunders, 2000; 214- 253.
Krol AL. Keratodermas. Dermatology. 2nd ed. Bolognia JL, Jorizzo JL, Rapini RP, eds. Spain. Elsewier Ltd, 2008; 777- 789.
Quatresooz P, Piérard-Franchimont C, Szepetiuk G, et al. Fungal chitin-glucan scaffold for managing diabetic xerosis of the feet in menopausal women. Expert Opin Pharmacother. 2009; 10: 2221- 2229.
Beebe-Dimmer JL, Pfeifer JR, Engle JS, et al. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005; 15: 175- 184.
Carpentier PH, Maricq HR, Biro C, et al. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France. J Vasc Surg. 2004; 40: 650- 659.
Fowkes FG, Evans CJ, Lee AJ. Prevalence and risk factors of chronic venous insufficiency. Angiology. 2001; 52: 5- 15.
Kamino H, Meehan SA, Pui J. Fibrous and fibrohistiocytic proliferations of the skin and tendons. Bolognia skin tag. Dermatology. 2nd edn. In: Bolognia JL, Jorizzo JL, Rapini RP, eds. Spain. Elsewier Ltd, 2008;1813- 1829.
Kahana M, Grossman E, Feinstein A, et al. Skin tags: a cutaneous marker for diabetes mellitus. Acta Derm Venereol. 1987; 67: 175- 177.
Muscelli E, Mingrone G, Camastra S, et al. Differential effect of weight loss on insulin resistance in surgically treated obese patients. Am J Med. 2005; 118: 51–57.
Maitra SK, Rowland Payne CM. The obesity syndrome and acanthosis nigricans. Acanthosis nigricans is a common cosmetic problem providing epidemiological clues to the obesity syndrome, the insulin-resistance syndrome, the thrifty metabolism, dyslipidaemia, hypertension and diyabetes mellitus type II. J Cosmet Dermatol. 2004; 3: 202–210.
Katz AS, Goff DC, Feldman SR. Acanthosis nigricans in obese patients; presentations and implications for prevention of atherosclerotic vascular disease. Dermatol Online J. 2000; 6: 1.
Hermanns-Lê T, Scheen A, Piérard GE. Acanthosis Nigricans Associated with Insulin Resistance: Pathophysiology and Management. Am J Clin Dermatol. 2004; 5: 199- 203.
Torley D, Bellus GA, Munro CS. Genes, growth factors and acanthosis nigricans. Br J Dermatol. 2002; 147: 1096-1101.
Hud Jr JA, Cohen JB, Wagner JM, et al. Prevalence and significance of acanthosis nigricans in an adult obese population. Arch Dermatol. 1992; 128: 941–944.
Fu F, Liang L, Dong GP, et al. Obese children with benign acanthosis nigricans and insulin resistance: analysis of 19 cases. Zhonghua Er Ke Za Zhi. 2004; 42: 917–919.
Barth JH, Ng LL, Wojnarowska F, Dawber RP. Acanthosis nigricans, insulin resistance and cutaneous virilism. Br J Dermatol. 1988; 118: 613–619.
Mistiaen P, Poot E, Hickox S, Jochems C, Wagner C. Preventing and treating intertrigo in the large skin folds of adults: a literature overview. Dermatol Nurs. 2004; 16: 43-57.
Loffler H, Aramaki JU, Effendy I. The influence of body mass index on skin susceptibility to sodium lauryl sulphate. Skin Res Technol. 2002; 8: 19–22.
Prinz JC. Nutritional diseases. Braun-Falco’s Dermatology. 3rd ed. In: Burgdorf WHC, Plewig G, Wolff HH, Landthaler M, ed. Berlin. Springer-Verlag Heidelberg, 2009; 1300- 1311.