An Overview of Dermatological Conditions Commonly
Associated with the Obese Patient
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References
1. National ...
hyperinsulinemia, excess body weight, and skin lesions in severe obesity with acanthosis nigricans. J
Endocrinol Invest. 1...
48. Tierney LM, McPhee SJ, Papadakis MA (eds). Medical Diagnosis and Treatment. Norwalk, Conn:
Appleton & Lange;1995.
49. ...
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  1. 1. An Overview of Dermatological Conditions Commonly Associated with the Obese Patient ! ! ! ! ! " ! #! ! $ ! ! ! % & " ! & ' % " & & && !' ! ' !! ' " ! & % ! & & "( & % % % ' % " & & ! & ' " ! )**+ & ,- % ' &. % ' ! /*"01 - # ($"2 - % ! 3 ' ! 4 ! 5 "6 &! ! & ' & ! & ! - ' ! "(& ( 7)0 % ' ! 87/* 8 7+* % "2 & ' /* ! ! " ! ! ! ! ! "9 - % & : ! ") ! ; & & ! & " ! ; ! % % ! 5 & "6 & & ' 8 ! ! "6 & 5 % 8 ' ' " & 5 ! & ! - "/ / &/+ ' '
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  3. 3. & & & & & ! 8 % C01 D01 " ! & ' ! & "6 & - " ! ++1 & 20 ' ! " && & "20 ( ; % % ! /+ ' ! ! ' % )0 #<+1$ & % % ' % & "/ & ' & % & ! % ' & ' "/ ! 5 " ! % !' "6 % & ! ' ' ! "+ ; 8 ' & % ! "2? 6 - ! ! " & - ! ! & ' 3 " 6 & ' "2? & ! & ! % & & ! & " ! % & & & "2< ' - ! ! % ! ' "B !3 ! " % ! "2C 6 ! & ! % " ( ; ! ! & % ' ! % "2D ! ! % ' % % ' ! "2D # $ & " & ! &
  4. 4. ' " ' & ")* 6 ! "6 ! & ! ")2 6 & ! ! & % 5 & & & ! " 6 ! & ' ' ! ")2 )) ! - ' ! @ A, ! - ! ! ! )* A ( && % & A ! & ") ! E )2 & & ! ' ! 8 % ! ! & ' ' ; ! ' ! & " ' F 20 &20? ' & +/1 & # G *"/$" ! & & " 6 & % & #' $ 4 & ! ")/ 6 & ! && ' "( ; % )+ &)) ' & ? " & ) & % #/)1$ ' ! & % # G "*0$ % # % ! & $ & 8 & ? C*1 % % & # G "**)$" & ? & % ' " ' % & % % && #/01 & & $F ' ! & ) & "6 % & ! % ! ' ' % ")+ 6 & ' & ' ")0 ( % &/D ' & && % ' & ? 2) & " ,% ' - ?*1 % ? & " & H && ! & && ! & & ! % & ! : "I20 6 ! & & & ! ' "( &20? ' ' ! & # G *"22$" ' % ' ! & ' ' ! <?1 2**1 ( "20 6 -
  5. 5. ' ! & ' & " ,- % ' ! & & & ! & % " 6 ! & & : ! F % " 6 & & " ' % ! ' ! ") ' % - % & & ' & & & " ! & ! & " & - - "9 ' & ! & & - "(& "6 & ' % "6 & & # 9! 2$") & ! !" B ! & % & - #E $ & ! ")? & "+ 6 & ! ' ' " !& ' ! ! ! & ")< )C % % ! ! ! ! & ! ' "(& ! & % & ! & & ! ' "2< 9 ; && % 8 ! ' % ")< 9 % '3 #' $ % "+ . ! 21 % !! ")0 9 ' & ' ; - "6 ! ! ; ' & ")C 9 ' ! ! - % % & & ' ! ' )+ ")D ! ' ' " ! ' % ! & & &' "6 ! & - ! % ")C ! ' ' ' ! & " & ' ' &
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
  7. 7. ")D ' % & ! % " ; ! ! 8 % ; ! "9 & ' & ! "9 & ! & ' " 5 ! ! & & ' "+2 ! & & % % & "6 & & 8 ' % ! & )C ! ! & ; 2DD?"+) ( </1 & ' ' - "+/ ( : & "( & 5 & # $ ' 4 & & "( % &2 2** & )*** <01 ' "++ ' ' & &% "> ! ! # 9! )$" ! ! "+2 ! % & ' "+) & & - % " ! ! ! "+2 ! > & ! ' & ! " /* ! ' && 8D*1 & ! "+0 > & ' - ! ' !"( % & ! & ! # ! !$"6 % ! & & & & ' & : "+? (& ! & & - ! % % ! ' & "+? % - ! ' & " (& - & ! ! "6 & & "+< % "6 & "+C "
  8. 8. 6 & ! && ! ' & & ' & & ", ! & % ! ! ' ! ! ! - "+D % % 5 - ! % # B $ ' & ! # >B$ ! ! - " ! ! ! 5 % % ! ! % & ' ! & - ! && " ' #' $ - ' - & ;". ) ' "+D & ' ! ",- ' ! % - & ' ! % ! ' ! & & " 6 ! ! & & " % & : "6 ' ' "6 && - ' "6 - ; % ! ' ") ! ! & % "6 & ! & ! ! & ! " & & ! & ' % ' "0* # ' & " ' & ' " 6 & & "02 % % 8 ' ' & " % % % % ' ' & ; & & % : "02 & "6 & ! ! ! & "6 !% & & : ! " B ! ! : "0) % & & " 6 ' % : & ! & & " (: & ! & ")D - ! ! ! & "
  9. 9. & ' ! ! % ! ' & % ")C 6 & " ' && " 6 ! & " ! ! ' % & % & & " % % & 8 % ' & & ! & " % % & ' % & ! " References 1. National Center for Health Statistics. Prevalence of overweight and obesity among adults: United States 2003–2004. Available at: www.cdc.gov/nchs. Accessed April 10, 2006. 2. Garcia-Hidalgo L. Dermatological complications of obesity. Am J Clin Dermatol. 2002;3(6):497–506. 3. Hud JA, Cohen JB, Wagner JM, et al. Prevalence and significance of acanthosis nigricans in an adult obese population. Arch Dermatol. 1992;128:941–944. 4. Mukhtar M. Surgical pearl: tissue forceps as a simple and effective instrument for treating skin tags. Int J Dermatol. 2006;45(5):577–579. 5. Katz A, Goff D, Feldman D. Acanthosis nigricans in obese patients: presentations and implications for prevention of atherosclerotic vascular disease. Dermatology Online Journal. 2000;6(1):1–12. 6. Cruz PD Jr, Hud JA Jr. Excess insulin binding to insulin-like growth factor receptors: proposed mechanism for acanthosis nigricans. J Invest Dermatol. 1992;98(6 suppl):82S–85S. 7. Stuart CA, Gilkison CR, Smith MM. Acanthosis nigricans as a risk factor for non-insulin dependent diabetes mellitus. Clin Pediatr. 1998;37(2):73–79. 8. Rendon MI, Cruz PD, Sontheimer RD, et al. Acanthosis nigricans: a cutaneous marker of tissue resistance to insulin. J Am Acad Dermatol. 1989;21:461–469. 9. Federman D, Brescia G, Horne M, Kirsner R. Cutaneous manifestations of malignancy. Postgraduate Medicine Online. 2004;115(1):1–13. 10. Wilegenbus K, Lenter A, Kuckelkorn K, Handt S, Mittermayer C. Further evidence that acanthosis nigricans maligna is linked to enhanced secretion by the tumor of transforming growth factor. Dermatol Res. 1992;284(5):266–270. 11. Baur W, Brine U, Doepfner W, et al. SMS 201-995: a very potent and selective octapeptide analogue of somatostatin with prolonged action. Life Science. 1982;31:1133–1140. 12. Lunetta M, DiMauro M, LeMoli R, Burrafato SL. Long term octreotide treatment reduced
  10. 10. hyperinsulinemia, excess body weight, and skin lesions in severe obesity with acanthosis nigricans. J Endocrinol Invest. 1996;19:699–703. 13. Bickle DD. Vitamin D: a calciotropic hormone regulating calcium-induced keratinocyte differentiation. J Am Acad Dermatol. 1997;37:41–52. 14. Blobstein S. Topical therapy with tretinoin and ammonium lactacte for acanthosis nigricans associated with obesity. Cutis. 2003;7(1):33–34. 15. Garcia-Hidalgo L, Orozco TR, Gonzalez-Barranco J, et al. Dermatoses in 156 obese adults. Obesity Research. 1999;7:299–302. 16. Wild R. Obesity, lipids, cardiovascular risk, and androgen excess. Am J Med. 1995;98:275–325. 17. Ross EV, Baxter DL. Widespread candida folliculitis in a nontoxic patient. Cutis. 1992;49:241–243. 18. Barnes R. Diagnosis and therapy of hyperandrogenism. Clin Obstet Gynaecol. 1997;11:369–396. 19. Deplewski D, Rosenfield RL. Role of hormones in pilosebaceous unit development. Endocr Rev. 2000;21:363–392. 20. Vinnet C, Bride J, Armbruster V, et al. Contractile forces generated by striae distensae fibroblasts embedded in collagen lattices. Arch Dermatol Res. 2005;287(1):10–17. 21. Singh G, Kumar LP. Striae distensae. Indian J Dermatol Venereol Leprol. 2005;71:370–372. 22. Pierard GE, Nizet Jl Adant JP, et al. Tensile properties of relaxed excised skin exhibiting striae distensae. J Med Eng Technol. 1999;23:69–72. 23. Strumia R. Dermatologic signs in patients with eating disorders. Am J Clin Dermatol. 2005;6(3):165–173. 24. Kang S, Kim KJ, Griffiths CEM, et al. Topical tretinoin (retinoic acid) improves early stretch marks. Arch Dermatol. 1996;132:519–526. 25. McDaniel D. Laser therapy of stretch marks. Derm Clin. 2002;20(1):67–76. 26. Hay RJ. The management of superficial candidiasis. J Amer Acad Dermatol. 1999;40:S35–S42. 27. Trent J, Federman D, Kirsner R. Common viral and fungal infections. Ostomy Wound Manage. 2001;47(6):28–34. 28. Gallagher S. Morbid obesity: a chronic disease with impact on wounds and related problems. Ostomy Wound Manage. 1997;43(5):18–27. 29. Gallagher S, Gates J. Obesity, panniculitis, panniculectomy, and wound care: understanding the challenges. J WOCN. 2003;30:334–341. 30. Derzie AJ, Silvestri F, Liriano E, Benotti P. Wound closure technique and acute wound complications in gastric bypass surgery for morbid obesity: a prospective, randomized trial J Am Coll Surg. 2000;191(3):238–243. 31. Armstrong M. Obesity as an intrinsic factor affecting wound healing. J Wound Care. 1998;7(5):220– 221. 32. Cooper D. Optimizing wound healing: a practice within nursing domain. Nurs Clin North Am. 1990;25:165–181. 33. Thelan L, Davie J, Urden L. Textbook of Critical Care Nursing: Diagnosis and Management. St. Louis, M: C.V. Mosby;1990. 34. Jacobson T. Obesity and the surgical patient: nursing alert. Ostomy Wound Manage. 1994;40(2):56–63. 35. West J. Wound healing in the surgical patient: influence of the stress response on perfusion. AACN Clinical Issues in Critical Care Nursing. 1990;1:595–601. 36. Hunt TK, VanWinkle W Jr. Normal repair. In: Hunt TK, Dunphy, JE (eds). Fundamentals of Wound Management. New York, NY: Apple-Century-Crofts;1990. 37. Zacharias A, Habib R. Factors predisposing to median sternotomy complications. Chest. 1996; 110:1173–1178. 38. Schwan T, Habib R, Zacharias A, et al. Effects of body size on operative, intermediate, and long- term outcomes after coronary artery bypass operation. Ann Thor Surg. 2001;71:521–531. 39. Johnson DW, Isbel NM, Brown AM, et al. The effect of obesity on renal transplant outcomes. Transplantation. 2002;54(5):675–681. 40. Chang N, Goodson W, Gotrup E, Hunt T. Direct measurement of wound and tissue oxygen tension in postoperative patients. Ann Surg. 1983;197:470–478. 41 Swartz M. Cellulitis. NEJM. 2004;350(9)904–912. 42. Stulberg DL, Penrod MA, Common bacterial skin infections. Am Fam Physician. 2002;66:119–124. 43. Grayson ML, McDonald M, Gibson K, et al. Once daily intravenous cefazolin plus oral probenecid is equivalent to one-daily intravenous ceftriaxone plus oral placebo for the treatment of moderate-to- severe cellulitis in adults. Clin Infect Dis. 2002;34:1440–1448. 44. Naimi TS, LeDell KH, Como-Sabetti K, et al. Comparison of community and health care associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003;290(22):2976–2984. 45. Macdonald J. Wound healing and lymphedema: a new look at an old problem. Ostomy Wound Manage. 2001;47(4):52–57. 46. Terry M, O’Brien SP, Kerstein MD. Lower-extremity edema: evaluation and diagnosis. WOUNDS. 1998;10:118. 47. Davis JM, Crawford PS. Persistent leg ulcers in an obese patient with venous insufficiency and elephantiasis. J WOCN. 2002;29:55–60.
  11. 11. 48. Tierney LM, McPhee SJ, Papadakis MA (eds). Medical Diagnosis and Treatment. Norwalk, Conn: Appleton & Lange;1995. 49. Kerr K, Watson W, Dalsing M. Chronic venous disease In: Fahey V (ed). Vascular Nursing. St. Louis, Mo: Saunders;2004:399–425. 50. Sieggreen M, Kline R. Current concepts in lymphedema management. Adv Wound Care. 2004;17(4):174–180. 51. Barr J, Cunneen J. Understanding the bariatric client and providing a safe hospital environment. Clin Nurs Special. 2001;15:5: 219–223. 52. Wilson J, Clark J. Obesity: impediment to wound healing. Crit Care Nurs Q. 2003;26(2):119–132.

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