Acanthosis Nigricans & Vascular Probs

Question 1

AN is considered a prognostic indicator of what?

Answer 1

• the development of DM type 2

- AN is linked to insulin resistance and obesity

Question 2

AN as marker for malignancy

Answer 2

• very rare
• only consider if it’s rapid onset, florid clinical findings, non-obese, non-DM adult
• the malignancies are primarily associated w/ GI tract

Question 3

pathophys behind the link of insulin resistance and AN

Answer 3

• excess insulin binds IGF-1 receptors on keratinocytes and dermal fibroblasts and stimulates proliferation
• EGFR and FGFR play a role in the absence of obesity and hyperinsulinemia

Question 4

what drugs can cause drug-induced AN

Answer 4

• systemic glucocorticoids
• niacin
• estrogen
• HGH

Question 5

clinical findings in AN

Answer 5

• symmetric, hyperpigmented, velvety to papillomatous, hyperkeratotic plaques
• in flexural areas: neck, axillae, groin, abdominal folds
• common to have superimposed acrochordons

Question 6

tx of AN

Answer 6

• first recognize and tx the hyperinsulinemia
• topical calcipotrial, urea, salicyclic acid, retinoids, and dermabrasion
• weight loss
• metformin for insulin sensitivity

Question 7

telangietctasia

Answer 7

• persistent dilations of small capillaries in the superficial dermis
• fine, bright, nonpulsatile red lines or net-like pattern
• will blanch w/ pressure

Question 8

cherry angioma

Answer 8

• very common
• bright red to violacious, domed vascular benign lesions (3mm)
• can be tiny red papular spots similar to petechiae
• strong family tendency
• mostly on trunk
• first appear around age 30

Question 9

management of cherry angiomas

Answer 9

• they are of no consequence other than cosmetic

- electro or laser removal

Question 10

spider angioma

Answer 10

• very common
• red focal telangiectatic network of dilated capillaries radiating from a central arteriole
• will blanch w/ pressure
• central arteriole may pulsate
• MC: face, forearms, hands
• F>M; children>adults

Question 11

what other conditions may spider angiomas be associated with?

Answer 11

• hepatocellular dz**
• hyperestrogen states
• pregnancy
• BCP

Question 12

management of spider angioma

Answer 12

• may regress spontaneously, esp. if arises in childhood or pregnancy
• may tx w/ electro or laster surgery

Question 13

venous lake

Answer 13

• dark blue to violaceous, asx soft papule
• dilated venule
• MC: face, lips, ears of pts > 50
• related to sun exposure
• compress w/ glass slide to differentiate b/w melanoma or BCC

Question 14

management of venous lake

Answer 14

• electro or laser surgery

- rarely surgical excision