New Study finds “Dark leathery skin over nape of the neck (Acanthosis Nigricans”)” is an important marker for liver damage among people with Type 2 Diabetes

C​handigarh, March 18, 2024: A recently published review study done by Fortis C-DOC hospital for Diabetes and Allied Sciences, AIIMS, Diabetes Foundation (India) and National Diabetes Obesity and Cholesterol Foundation (NDOC) has found that an easily identified skin condition, Acanthosis Nigricans, among Indians can be indicative of high risk of liver cell damage (fibrosis) in people with type 2 diabetes. Characterized by thickening, dark pigmentation, and velvety appearance of the skin, is typically observed at the nape of the neck. However, it can also manifest in other areas such as the axillae, elbows, knees, and groin. This is usually found in individuals with insulin resistance. Interestingly, once seen, a non-medical person can easily recognize it too!

The study has been co-authored by Dr Anoop Misra, Padma Shri, Executive Chairman & Director, Diabetes and Endocrinology, Fortis C-Doc Hospital for Diabetes and Allied Sciences, along with Koel Dutta, Surya Prakash Bhatt, Swati Madan, Irshad Ahmad Ansari, Kanika Tyagi and Shivam Pandey, representing partner institutions.

Study findings:

Acanthosis Nigricans has the potential to be used as an easy-to-identify clinical marker for risk of hepatic fat and fibrosis in Asian Indians with type 2 diabetes, allowing for early detection and management strategies. Assessment of Acanthosis Nigricans among Asian Indians is of importance due to the relatively high magnitude of insulin resistance and early onset of type 2 diabetes, contributed by major changes in dietary and lifestyle practices. There is strong correlation of the skin issue with type 2 diabetes, particularly in women, overweight/obese individuals and those with a family history of type 2 diabetes. In this study, the correlation with severity of neck Acanthosis Nigricans was strongest, with fasting insulin and glucose levels, and insulin resistance as compared to the disease at other sites, that is, axilla, and knuckles.

Methodology:

The methodology involved assessment of 150 people with T2D with AN and an equal number without AN, were recruited from Fortis-CDOC Hospital for Diabetes and Allied Sciences, New Delhi, India after obtaining ethics committee approval and registering for Clinical Trial registry India (CTRI/2023/06/054229). Patients’ physical details were recorded, and biochemical tests were conducted. A complete evaluation of only neck Acanthosis Nigricans was done, appearance of the condition was graded depending on the texture and severity of its extent. All patients underwent abdominal sonography for the assessment of liver span and hepatic steatosis using a special machine, Fibroscan.

According to Dr Anoop Misra, Padma Shri, co-author of the study and Executive Chairman & Director, Diabetes and Endocrinology, Fortis C-Doc Hospital, “In this case-control study involving patients with type 2 diabetes, we made important observations indicating an independent association between the presence of Acanthosis Nigricans and hepatic steatosis and fibrosis (adverse markers of liver damage)”.

Lead author Koel Dutta, Clinical associate and diabetes educator, Fortis C-Doc Hospital stated: “Importantly, our study provides novel data on Acanthosis Nigricans as a clinical marker in relation to liver fat and stiffness, as no prior studies have reported such findings. Furthermore, these findings introduce a new and easy-to-identify clinical marker for assessing liver health in patients with type 2 diabetes.”