A study of dermatological manifestations of obesity in a tertiary care center

 

Pralhad R Rathod¹, Nachiket Palaskar^2*

 

Abstract              Background: In obesity there is a concomitant increase in many of the associated co-morbidities 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. Aim & objective: To study the cutaenous manifestations in obesity. Methodology: Total 100 patients were studied in OPD of Medicine Department. Data was collected with pretested questionnaire. Data collection included sociodemographic data, detailed history and clinical examination. A detailed skin examination (including hair, scalp and nails) was done. Results & discussion: Out of all patients 38 were males and 62 were females. Mean age of the patients was 37.27± 3.5 years. Mean BMI was 35±4.61 kg/m². The skin (cutaneous) manifestations in obese patients. commonly encountered manifestations were Acanthosis nigricans, Striae, Fungal infections, Bacterial infections, Acrochordons, Viral infections, Hirsutism, Xanthoma, Corn, Plantar hyperkeratosis, Acne, Varicosities, Psoriasis and Callus. Obesity grade II ( BMI >30 kg/m2) was found to be significantly associated with acanthosis nigricans, striae. viral infections and hirsutism (p<0.05).

Key Word: obesity.

 

INTRODUCTION

Obesity is a chronic disease associated with a variety of complications resulting from the deposition and accumulation of excess adipose tissue¹ The pattern of food intake nowadays has generated change in lifestyle adopted by the people, adapted to new conditions of time, money, work, frequency of purchase, and others^2,3.

Obesity causes problems all over the body. It has cutaenous manifestations too. Skin manifestations in obesity has a wide spectrum, it includes acanthosis nigricans, acrochordons, keratosis pilaris, hyperandrogenism and hirsutism, striae distensae, adiposis dolorosa, and fat redistribution, lymphedema, chronic venous insufficiency, plantar hyperkeratosis, cellulitis, skin infections, hidradenitis suppurativa, psoriasis, insulin resistance syndrome, and tophaceous gout. Excess body fat leads to extra folds of skin. The combination of moisture, warmth and skin rubbing against skin leaves these areas more susceptible to bacterial and fungal infection. Obesity has several hormonal and chemical imbalances which causes these skin problems. This study was conducted to study the cutaenous manifestations in obesity.

 

MATERIAL AND METHODS

Present study was carried out in 100 patients attending medicine OPD. Study population included having body mass index (BMI) >25kg/m2 with cutaenous manifestations of obesity. Inclusion criteria: 1. Patients above 18 years.2. BMI > 25 kg/m2. And skin manifestation Exclusion criteria: skin changes secondary to 1.systemic illnesses 2.pregnancy 3.Drugs

Study was approved by ethical committee. A valid written consent was taken from patients after explaining study to them.

Data was collected with pretested questionnaire. Data collection included sociodemographic data, detailed history and clinical examination. A detailed skin examination (including hair, scalp and nails) was done. BMI was calculated using the formula weight (kg) /height (m)2. Cases were labeled as obesity grade I and obesity grade II as per classification of BMI by WHO.⁴ Special investigations for skin infections pecial tests like Wood’s lamp examination, scraping for fungus, skin biopsy, Tzanck smear, nail biopsy and nail clippings were performed where required. Data was analyzed with appropriate statistical tests.

 

RESULTS

Table 1: Skin manifestations in obese patients

Study population was 100. Out of all patients 38 were males and 62 were females. Mean age of the patients was 37.27± 3.5 years. Mean age of male patients was 38.41± 3.1 years. Mean age of female patients was 36.3± 3.9 years. Out of total study population 44 were having BMI ranging between 25 to 29.9Kg/m2 (grade I obesity) and 56 were BMI above or equal to 30Kg/m2 (grade II obesity). Mean BMI was 35±4.61 kg/m². Table 1 shows the skin (cutaneous) manifestations in obese patients. commonly encountered manifestations were Acanthosis nigricans, Striae, Fungal infections, Bacterial infections, Acrochordons , Viral infections, Hirsutism, Xanthoma, Corn, Plantar hyperkeratosis, Acne, Varicosities, Psoriasis, Callus and other like Adiposis dolorosa, Hidradenitis suppurativa , Lichen planus and Stasis ulcer. Most commonly found was Acanthosis nigricans (48%) followed by striae (16%), fungal infections (13%), hirsuitism (13%). Viral infections were seen in 9 % patients. Acanthosis nigricans was seen more in females (59.67%) than males (28.95%). Similarly viral infections and hirsuitism were common in females. Corn was observed more in males (15.78%) than in females (1.61%). Bacterial infections were more common in males (10.52%) than females (3.22%). Other skin manifestations were seen in almost equal proportion in males and females. (table 2) Obesity grade II ( BMI >30 kg/m2) was found to be significantly associated with acanthosis nigricans, striae. viral infections and hirsutism (p<0.05). However, no significant difference in bacterial and fungal infections.

DISCUSSION

Out of all patients 38 were males and 62 were females. Mean age of the patients was 37.27± 3.5 years. Mean BMI was 35±4.61 kg/m2 in our study. Similar findings were seen in Hermanns et al.⁵ They observed mean BMI 37.4 kg/m2. In a study by Flegal et⁶ al higher mean was observed in females than in males. Most commonly found manifestations were Acanthosis nigricans (48%) followed by striae (16%), fungal infections (13%), hirsuitism (13%). Viral infections were seen in 9 % patients. similar findings were observed in Ahsan et al⁷, Hermanns et al ⁵. Boza et al.⁸ also reported the association of obesity and acanthosis nigricans. Hud et al.⁹ found that 74% of obese population shows AN along with elevated plasma insulin levels. Obese children with AN also have insulin resistance. Decreased numbers of functional insulin receptors cause a shift to increased binding to IGF receptors contributing to the development of acanthosis nigricans.¹⁰ In our study we observed striae contributing 16% of all. They were associated with increasing grade of obesity. Similar findings were observed in previous studies.^7,8 Skin infections were common in our study in obese patients (28%). Out of them 9% were viral infections ,13% were viral infections and were 6% bacterial infections, Hus et al.¹¹ reported a Skin infections are usually more in frequency in obese patients. Boza et al.⁸ found a statistically significant association of obesity with infections. The macerated erythematous plaques developing within skin folds, such as inframammary, genitocrural, axillary, and abdominal folds, are due to both increased friction and moisture within these areas. Obese patients have larger skin folds and sweat more profusely after becoming overheated because of thick layers of subcutaneous fat, thus increasing both frictional and moisture components.¹² In our study, hirsutism (18%) had a significant association with obesity grade II (p=0.04). Ahsan et al.⁷ have reported similar findings. Hirsutism has already been reported to be associated with hyperinsulinaemia and hyperandrogenism in previous studies.¹³

 

CONCLUSION

Skin care in obese patients is important because of morbidity and susceptibility to infections.

 

REFERENCES

1. Batista Filho M, Rissin A. A transição nutricional no Brasil: tendências regionais e temporais. Cad. Saúde Pública, 2003; 19(1):181-191.
2.  Isomaa B, Henricsson M, Almgren P, Tuomi T, Taskinen MR, Groop L. The metabolic syndrome influences the risk of chronic complications in patients with type II diabetes. Diabetologia. 2001 Sep;44(9):1148-54.
3.  James PT, Leach R, Kalamara E, Shayeghi M. The worldwide obesity epidemic. Obes Res. 2001 Nov;9 Suppl 4:228S-233S. 
4. World Health Organization, Regional Office for the Western Pacific, International Association for the Study of Obesity. International Obesity Task Force. The Asia- Pacific perspective: redefining obesity and its treatment. Melbourne, Health Communications Australia, 2000.
5. Hermanns-Le T, Scheen A, Pierard GE. Acanthosis nigricans associated with insulin resistance: pathophysiology and management. Am J Clin Dermatol.2004;5:199-203.
6. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307:491-7.
7. Ahsan U, Jamil A, Rashid S et al. Cutaneous manifestations in obesity. J Pak Assoc Dermatol. 2014;24:21-4.
8. Boza JC, Trindade EN, Peruzzo J et al. Skin manifestations of obesity: a comparative study. J Eur Acad Dermatol Venereol. 2012;26:1220-3.
9. Hud JA Jr, Cohen JB, Wagner JM, Cruz PD Jr. Prevalence and significance of acanthosis nigricans in adult obese population. Arch Dermatol. 1992;12:941-4.
10. Rendon MI, Cruz PD Jr, Sontheimer RD, Bergstresser PR. Acanthosis nigricans: a cutaneous marker of tissue resistance to insulin. J Am Acad Dermatol 1989;21:461-9.
11. Hus HS, Chen W, Chen SC, Ko FD. Colored striae in obese children and adolescents. Zhonghua Min Guo. Xia Er KeYi Xue Hui Za Zhi. 1996;37:349-52.
12. Garcia-Hidalgo L. Dermatological complications of obesity. Am J Clin Dermatol 2002;3:497-506.
13. Kopera D, Wehr E, Obermayer-Pietsch B. Endocrinology of hirsutism. Int J Trichol. 2010;2:30-5.