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Symmetric hyperpigmented velvety plaques most commonly on the neck, axillae, and/or groin; associations can include internal malignancy, autosomal dominant inheritance, or endocrinopathy.
Hyperkeratosis, papillomatosis with mild acanthosis of epidermis
  • Mild hyperpigmentation of basal layer.
  • Work-Up Considerations:

    • This is primarily a clinical diagnosis
    • A skin biopsy can be performed if the diagnosis is in doubt
    • Full history, physical examination and review of systems necessary to evaluate for the possibility of an underlying medical condition
    • Measure body weight and vital signs.
    • Additional work-up may include but are not limited to: glucose tolerance test, hemoglobin A1C levels, plasma insulin level, fasting lipid profile, and age appropriate malignancy screening and additional cancer screening as indicated by signs and symptoms
    • Additional work-up for other endocrinopathies (e.g. acromegaly, polycystic ovary syndrome, Cushing syndrome, etc.) may be indicated.
    • May be associated with medications.

    Treatment:

    • If iatrogenic cause is suspected, identify culprit drug and discontinue it if clinically feasible.
    • Identify and treat underlying medical condition
    • Referral to appropriate subspecialist depending on underlying cause.
    • If related to obesity, advise patient on healthy diet and active lifestyle
    • Referral to dietician may be helpful.
    • Treatment to improve appearance of lesions include: topical keratolytics, topical and oral retinoids, oral metformin, topical vitamin D analogs, laser therapy.
    Associated with Insulin resistant DM, Obesity and PCOS.
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