title: Hyperinsulinemia associated with acanthosis nigricans, finger pebbles, acrochordons, and the sign of Leser-Trélat.
abstract: OBJECTIVE
  To review common skin manifestations associated with type 2 diabetes mellitus (DM), and to discuss a potential underlying mechanism for these manifestations.
  
  
  METHODS
  A PubMed literature search was conducted for articles describing the skin manifestations associated with hyperinsulinemia and type 2 DM. A case presentation describes a morbidly obese patient with type 2 DM treated with metformin who developed acanthosis nigricans, finger pebbles, scores of skin tags (acrochordons), and the sign of Leser-Trélat (sudden onset shower of seborrheic keratoses) in the absence of internal malignancy.
  
  
  RESULTS
  Acanthosis nigricans, acrochordons, and finger pebbles have been associated with type 2 DM and obesity. While the Leser-Trélat sign is classically associated with internal malignancy, it can also be idiopathic. To our knowledge, this the first report of the occurrence of the Leser-Trélat sign in a patient with DM absent internal malignancy.
  
  
  CONCLUSIONS
  Several skin manifestations can be seen in this patient with DM because of underlying insulin resistance and subsequent stimulation of insulin-like growth factor receptors. Management strategies could include weight loss, diet, and insulin-sensitizing pharmacologic therapy.
authors: Northeast Ohio Medical University, Rootstown, Ohio, USA.
authors: Ami
authors: A
authors: Saraiya
authors: Ahmad
authors: A
authors: Al-Shoha
authors: Robert T
authors: RT
authors: Brodell
mesh_terms: D000052:Acanthosis Nigricans / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism; D006801:Humans; D017451:Receptors, Somatomedin / Q000378:metabolism; D012871:Skin Diseases / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism
chemical_list: D017451:Receptors, Somatomedin