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November 10, 2014

Diagnosis and Symptoms

Question from Minneapolis, Minnesota, USA:

I pointed out a "dirty neck" to our pediatrician today, concerned that my son (Caucasian, 10 years old) has acanthosis nigricans. The doctor said it did look like AN and wanted us to see a pediatric endocrinologist and do a battery of tests to isolate an autoimmune process or inflammation in place. I haven't had any of kids tested for the gene (I've had type 1 for 29 years, since I was 13)...uncomplicated, great control. I just dread it for my child. Are we heading down that path? What else would you be sure to ask for, to test? He isolated immunoregulatory tests: Sed Rate (erythrocyte sedimentation rate ), CRP (C-reactive protein), complement? He also wants us to see dermatologist for psoraisis. My 10-year-old is my child with inflammatory issues. What is your opinion?

Answer:

The pictures area fairly classical if you go to acanthosis nigricans on Google images. It is usually associated with obesity and we believe it indicates insulin resistance related to weight excess. Though more common in people of color, it can occur in anyone. Future risks are type 2 (not type 1 diabetes) and all that goes along with it: heart disease, hypertension, high lipid levels, strokes, etc. The key treatment is weight loss with lowered calories and increased daily exercise. Tests would include blood glucose, hemoglobin A1c, lipid levels, liver function tests at a minimum. Family history is important to highlight genetic risk factors. It is not necessarily related at all to your type 1 diabetes which is, most of the time, an autoimmune attack on the pancreas. It is good that you have set up an evaluation with a pediatric endocrinologist/diabetologist.

SB