Prevalence, Predictors and Morphological Patterns of Acanthosis Nigricans Between Obese Non-diabetic Patients on Second Generation Antipsychotics Versus Non-obese Insulin Dependent Diabetes mellitus: A Nested Case-Control Study
- Authors: Vidyasagar P.1, Kamble A.1, Khairkar P.1, Shravya B.1, Sumera Y.1, Matety A.R.1, Reddy V.1, Biswas R.1, Ransing R.2
-
Affiliations:
- Kamineni Institute of Medical Sciences
- BKL Walawalkar Rural Medical College
- Issue: Vol 31, No 1 (2023)
- Pages: 59-68
- Section: Original study
- URL: https://journal-vniispk.ru/pavlovj/article/view/252523
- DOI: https://doi.org/10.17816/PAVLOVJ95519
- ID: 252523
Cite item
Abstract
INTRODUCTION: There is no study in literature for analyzing acanthosis nigricans (AN) in psychotropic induced obesity or hypercholesterolemia.
AIM: To assess the prevalence and explore the predictors and morphological patterns in AN in patients on antipsychotics induced hypercholesterolemia versus those with diabetes mellitus.
MATERIALS AND METHODS: 491 schizophrenia patients on second generation antipsychotics were screened. 26 out of 491 patients have AN and cholesterol > 200 mg/dl but non-diabetic. We used Mann–Whitney U-test, Pearson’s ÷2 test, Fischer Exact and Spearman’s correlation coefficient.
RESULTS: In the group of antipsychotics induced hypercholesterolemia having developed AN in 5.29% (26 out of 491) of individuals, we observed significance of Burke’s knuckle (p < 0.001), knee (p = 0.002), elbow (p = 0.042) compared to patients without hypercholesterolemia. Interestingly Burke’s neck severity (p < 0.001), neck texture (p = 0.001) and axilla (p = 0.007) index also showed marked differences on Mann–Whitney U-test and Wilcoxson W-test. On Spearman’s correlation coefficient antipsychotics induced hypercholesterolemia was found to affect most positively and significantly as the emergence of AN specifically for neck texture (ρ = 0.413, p = 0.003) compared to other bodily regions.
CONCLUSION: About 5.29% prevalence of AN in the group having obesity secondary to psychotropic drugs which was significantly less than what even non-obese, insulin dependent diabetic patients who almost had 13.55% prevalence, close to three times. This suggests that diabetes is strongly linked with occurrence of AN lesions and might reflect the continuity in the paradigm of metabolic syndrome as its definitive predictor of severity while obesity is the initiation of phase shift in the process.
Full Text
##article.viewOnOriginalSite##About the authors
Pappula Vidyasagar
Kamineni Institute of Medical Sciences
Email: Sgarpappula@gmail.com
ORCID iD: 0000-0001-6359-2603
MBBS, MD
India, NarketpallyAshwini Kamble
Kamineni Institute of Medical Sciences
Email: dr.ashwinipravin@gmail.com
ORCID iD: 0000-0003-3396-8010
MD, Dr. Sci. (Chem.), Professor
India, NarketpallyPraveen Khairkar
Kamineni Institute of Medical Sciences
Email: praveen.khairkar280@gmail.com
ORCID iD: 0000-0003-3166-3547
MD, Dr. Sci. (Med.), Professor
India, NarketpallyBogum Shravya
Kamineni Institute of Medical Sciences
Email: shravyab04@gmail.com
ORCID iD: 0000-0001-6490-1754
MBBS, MD
India, NarketpallyYasmin Sumera
Kamineni Institute of Medical Sciences
Email: dr.sumeray@gmail.com
ORCID iD: 0000-0002-6142-7222
MBBS, MD
India, NarketpallyAshok Rao Matety
Kamineni Institute of Medical Sciences
Email: armatety@yahoo.co.in
ORCID iD: 0000-0002-2585-6783
MBBS, MD
India, NarketpallyVishwak Reddy
Kamineni Institute of Medical Sciences
Email: vishwakreddy.v@gmail.com
ORCID iD: 0000-0003-1133-3612
MBBS, MD
India, NarketpallyRakesh Biswas
Kamineni Institute of Medical Sciences
Email: rakesh7biswas@gmail.com
ORCID iD: 0000-0001-7694-3660
MBBS, MD
India, NarketpallyRamdas Ransing
BKL Walawalkar Rural Medical College
Author for correspondence.
Email: ramdas_ransing123@yahoo.co.in
ORCID iD: 0000-0002-5040-5570
MBBS, MD
India, MaharashtraReferences
- Schwartz RA. Acanthosis nigricans. Journal of the American Academy of Dermatology. 1994;31(1):1–19; quiz 20–2. doi: 10.1016/s0190-9622(94)70128-8
- Ng HY. Acanthosis nigricans in obese adolescents: prevalence, impact and management challenges. Adolescent Health, Medicine and Therapeutics. 2016;8:1–10. doi: 10.2147/AHMT.S103396
- Moehlig RC, Rachmaninoff N. Acanthosis nigricans with endocrinopathy. JAMA. 1961;178(9):949–50. doi: 10.1001/jama.1961.73040480033018d
- Hermanns–Lê T, Hermanns JF, Piérard GE. Juvenile acanthosis nigricans and insulin resistance. Pediatric Dermatology. 2002;19(1):12–4. doi: 10.1046/j.1525-1470.2002.00013.x
- James WD, Berger TG, Elston DM, et al. Andrew’s Diseases of the Skin: Clinical Dermatology. 12th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. P. 494–5.
- Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: skin physiology and skin manifestations of obesity. Journal of the American Academy of Dermatology. 2007;56(6):901–16; quiz 917–20. doi: 10.1016/j.jaad.2006.12.004
- Hoffmann M, Visser WI, Ascott–Evans B, et al. The prevalence and clinical significance of acanthosis nigricans in diabetic and non-diabetic women of mixed ancestry. Journal of Endocrinology, Metabolism and Diabetes of South Africa. 2015;20(2):87–91. doi: 10.1080/16089677.2015.1056473
- Stoddart ML, Blevins KS, Lee ET, et al. Association of acanthosis nigricans with hyperinsulinemia compared with other selected risk factors for type 2 diabetes in Cherokee Indians: The Cherokee Diabetes Study. Diabetes Care. 2002;25(6):1009–14. doi: 10.2337/diacare.25.6.1009
- Gautam S, Meena PS. Drug-emergent metabolic syndrome in patients with schizophrenia receiving atypical second-generation antipsychotics. Indian Journal of Psychiatry. 2011;53(2):128–33. doi: 10.4103/0019-5545.82537
- Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004;27(2):596–601. doi: 10.2337/diacare.27.2.596
- Brown S, Birtwistle J, Roe L, et al. The unhealthy lifestyle of patients with schizophrenia. Psychological Medicine. 1999;29(3):697–701. doi: 10.1017/s0033291798008186
- Lieberman JA 3rd. Metabolic changes associated with antipsychotic use. Primary Care Companion to the Journal of Clinical Psychiatry. 2004;6(Suppl 2):8–13.
- Bustillo JR, Buchanan RW, Irish D, et al. Differential effect of clozapine on weight: a controlled study. The American Journal of Psychiatry. 1996;153(6):817–9. doi: 10.1176/ajp.153.6.817
- Shin J–A, Lee H–J, Lim S–Y, et al. Metabolic syndrome as a predictor of type 2 diabetes and its clinical interpretations and usefulness. Journal of Diabetes Investigation. 2013;4(4):334–43. doi: 10.1111/jdi.12075
- Ford ES, Li C, Sattar N. Metabolic syndrome and incident diabetes: current state of evidence. Diabetes Care. 2008;31(9):1898–904. doi: 10.2337/dc08-0423
- Wilson PWF, D’Agostino RB, Parise H, et al. Metabolic syndrome as precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation. 2005;112(20):3066–72. doi: 10.1161/CIRCULATIONAHA.105.539528
- Wannamethee SG, Shaper AG, Lennon L, et al. Metabolic syndrome vs Framingham Risk Score for prediction of coronary heart disease, stroke, and type 2 diabetes mellitus. Archives of Internal Medicine. 2005;165(22):2644–50. doi: 10.1001/archinte.165.22.2644
- Stefanadi EC, Dimitrakakis G, Antoniou C–K, et al. Metabolic syndrome and the skin: a more than superficial association. Reviewing the association between skin diseases and metabolic syndrome and clinical decision algorithm for high risk patients. Diabetology & Metabolic Syndrome. 2018;10:9. doi: 10.1186/s13098-018-0311-z
- Fizelova M, Jauhiainen R, Kangas AJ, et al. Differential Associations of Inflammatory Markers with Insulin Sensitivity and Secretion: The Prospective METSIM Study. Journal of Clinical Endocrinology and Metabolism. 2017;102(9):3600–9. doi: 10.1210/jc.2017-01057
- Padhi T., Garima. Metabolic syndrome and skin: psoriasis and beyond. Indian Journal of Dermatology. 2013;58(4):299–305. doi: 10.4103/0019-5154.113950
- Biesheuvel CJ, Vergouwe Y, Oudega R, et al. Advantages of nested case-control design in diagnostic research. BMC Medical Research Methodology. 2008;8:48. doi: 10.1186/1471-2288-8-48
- Burke JP, Hale DE, Hazuda HP, et al. A quantitative scale of acanthosis nigricans. Diabetes Care. 1999;22(10):1655–59. doi: 10.2337/diacare.22.10.1655
- Guran T, Turan S, Akcay T, et al. Significance of acanthosis nigricans in childhood obesity. Journal of Paediatrics and Child Health. 2008;44(6):338–41. doi: 10.1111/j.1440-1754.2007.01272.x
- Sayarifard F, Sayarifard A, Allahverdi B, et al. Prevalence of Acanthosis nigricans and Related Factors in Iranian Obese Children. Journal of Clinical and Diagnostic Research. 2017;11(7):SC05–7. doi: 10.7860/JCDR/2017/24902.10203
- González–Saldivar G, Rodríguez–Gutiérrez R, Treviño–Alvarez AM, et al. Acanthosis nigricans in the knuckles: An early, accessible, straightforward, and sensitive clinical tool to predict insulin resistance. Dermatoendocrinology. 2018;10(1):e1471958. doi: 10.1080/19381980.2018.1471958
- Murahovschi V, Pivovarova O, Ilkavets I, et al. WISP1 is a novel adipokine linked to inflammation in obesity. Diabetes. 2015;64(3):856–66. doi: 10.2337/db14-0444
- Wang A–R, Yan X–Q, Zhang C, et al. Characterization of Wnt1-inducible Signaling Pathway Protein-1 in Obese Children and Adolescents. Current Medical Science. 2018;38(5):868–74. doi: 10.1007/s11596-018-1955-5
- Liu L–C, Xu S–T, Li L. WISP1 is increased in the maternal serum, adipose tissue, and placenta of women with gestational diabetes mellitus. International Journal of Diabetes in Developing Countries. 2022;42(Suppl 1):269–75. doi: 10.1007/s13410-021-00972-2
- Koro CE, Fedder DO, L'Italien GJ, et al. Assessment of independent effect of olanzapine and risperidone on risk of diabetes among patients with schizophrenia: population based nested case-control study. BMJ. 2002;325(7358):243. doi: 10.1136/bmj.325.7358.243
Supplementary files
