Acanthosis nigricans in obese patients: Presentations and implications for prevention of atherosclerotic vascular disease.

Acanthosis nigricans is traditionally characterized by hyperpigmented, velvety plaques of body folds. Involvement of other areas occurs as well. The condition is caused by hyperinsulinemia, a consequence of insulin resistance that occurs associated with obesity. As the frequency and degree of obesity increase in the population, a concomitant increase in acanthosis nigricans can be expected. The dermatologist has an important role in identifying the subset of obese patients with acanthosis nigricans. These patients have hyperinsulinemia and may be at greater risk of consequent atherosclerotic cardiovascular disease. It is essential for dermatologists to recognize the many presentations of acanthosis nigricans to identify patients at risk for associated medical conditions. This article illustrates a variety of presentations of acanthosis nigricans associated with insulin resistance.