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October 15, 2000


Question from Chennai, India:

I have a skin problem for the past 15 years, and the doctors do not seem able to diagnose it. The skin becomes thick, dark, dry, but no itching, and there are a lot of tiny dots near the area. Most of the places are at the joints of fingers and toes, and it is spreading further. Recently the tests showed the following: fasting insulin level was normal and blood sugar was 113 mg/dl [6.3 mmol/L]. The doctor says that my body is insulin resistant, and he has termed my skin problem as Acanthosis Nigricans. Is the diagnosis correct?


Given the constraints of the Internet, I cannot be sure that your problem is truly Acanthosis Nigricans. However, this is a common skin lesion seen in individuals who have marked insulin resistance. It is generally described as being around the neck or intertrigenous [skin fold] areas in the groin or knees. It is a raised confluent plaque, often described as velvety in texture. It truly is a marker of the insulin resistance status. Decreased resistance is associated with improved skin findings. However, I am not confident there are other topical treatments which are very helpful.