Hyperpigmented LipCorner; An Unusual presentation of Acanthosis Nigricans: A Case Report

Filiz Cebeci1, Ekin Ozge Ozdemir2, Sirin Yasar3, Sema Aytekin3 and Havva Keskin4* 1Department of Dermatology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Turkey 2Department of Dermatology, Ministry of Health University Istanbul Sisli Hamidiye Etfal Education and Research Hospital, Turkey 3Department of Dermatology, Ministry of Health University Istanbul Haydarpasa Education and Research Hospital, Turkey 4Department of Internal Medicine, Istanbul Medeniyet University Goztepe Training and Research Hospital, Turkey


Introduction
Acanthosisnigricans (AN) is one of the common dermatologic manifestations of obesity and insulinresistance. These lesions are characterized thickenin gand the hyperpigmented darkened lesion and they are located in the flexuralare as of the skin or on themucosal surfaces. These darkened lesions are the typical settlement symmetric in axilla, neck, andgroin. Besides obesity and endocrine syndromes, the other common reasons for AN are genetic, auto immune, paraneo plastic conditions, some medical treatment, andi diopathic [1,2]. In this report, we present a patient with AN who has type 2 diabetes, hypertension, hyperlipidemia, andobesity. Her lesions were described on the neckand on the bilateral lip corners where AN is not usually located.

Current Research in Diabetes & Obesity Journal
In this case report, a 56-year-old woman with the hyper pigmented, thicken in glesionson theneck and on the bilateral lip corners was presented for an evaluation. Her lesions were first recognized almost one-year ago, and various types of topical creams were used for treatment. Her examination report revealed that she is obese (body mass index: 32kg/m 2 ) and there were hirsutism, a general increase in pigmentation throughout the body, thickening skin by the brown-velvety appearance of the lip corners and the neck (Figure 1 & 2). The similar skin lesions were present in her inter triginous regions. A can thos is and marked papillomatos is were detected by biopsy.
She didn't have the history of type 2 diabetes, hypertension, hyperlipidemia, and malignan this tory before. Her an thropometric measures and metabolic evaluation were compatible with the metabolic syndrome, type 2 diabetes, hypertension, and hyper lipidemia. A pathology that would suggest malignancy was not detected. She was referred to internal medicine department to evaluate her treatment and modify as needed. Her treatment plan was included treatment of type 2 diabetes, hypertension, hyperlipidemia, and the institution of weight loss measures.

Discussion
Over the past several decades, while obesity and metabolic syndrome were a growing health problem across the developed countries, obesity-related co-morbidities such as metabolic, cardiovascular, carcinogenic, musculo skeletal and cutaneous disorders have been increased. AN is related to cancer as well as obesity, and endocrined is orders including diabetes mellitus, hyper insulinemia, insulin resistance, and metabolic syndrome [3,4]. AN may be a sign of some type of cancer when it is evident in an obese person. Therefore, when AN is diagnosed, along with metabolic disorders, malignancy should be eliminated too. This case didn't have any malignant lesion, but she had metabolic syndrome and insulin resistance (type 2 diabetes).
AN can be observed in the non classic locations such as the face, eyelid, circumference of the umbilicus, palmo plantar region, external genital area, breast are ola and mucosal involvement as we observed in our case [5]. This case highlights the importance of AN on the lip corners where AN is rarely located. This case shows that AN can be located in non classical regions on the skin or mucosal surface and we need to be more cautious and alert in routine clinical practice at internal medicine clinics.