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Correspondence |

Exogenous Insulin-Derived Acanthosis Nigricans

Erica A. Mailler-Savage, MD; Brian B. Adams, MD, MPH
Arch Dermatol. 2008;144(1):126-127. doi:10.1001/archdermatol.2007.27.
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Acanthosis nigricans presents as asymptomatic tan to dark brown velvety plaques usually on the posterior neck and intertriginous areas. It is often a cutaneous manifestation of insulin resistance. Histopathologically, lesions demonstrate hyperkeratosis, papillomatosis, acanthosis, and a thickened dermis. Acanthosis nigricans at the site of repeated insulin injections has been reported at least twice previously in the literature.1,2 The activation of insulinlike growth factor (IGF) receptors due to high circulating levels of insulin likely causes this lesion.3

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Figure 1.

Presentation of exogenous insulin-derived acanthosis nigricans. A, Circumscribed dark brown plaque on the left lower abdomen. B, Hyperkeratotic, dark brown, verrucous plaque.

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Figure 2.

Hyperkeratosis, papillomatosis, acanthosis, a thickened dermis, and superficial and deep perivascular infiltrate (hematoxylin-eosin, original magnification ×40).

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