In a paper published earlier this year in the Spanish journal Actas Dermo-Sifiliográficas, Gómez and colleagues investigated the association between skin tags and diabetes, asking if acanthosis nigricans, skin tags, keratosis pilaris and even plantar hyperkeratosis could be a useful indicator of underlying metabolic issues in patients as yet undiagnosed with diabetes.
Acanthosis Nigricans and Diabetes
The authors looked at 109 patients with obesity, including 95 adults, and assessed the levels of skin conditions and any association between these and the patients’ degree of obesity. Almost all of the patients (97%) had acanthosis nigricans, a condition where the skin develops a brown or black velvety hyperpigmentation that is typically poorly defined and seen in folds of skin such as in the neck, armpits, groin, navel, and forehead.
Skin Tags, Keratosis Pilaris, and Plantar Hyperkeratosis
The majority of the patients also had skin tags (77%), and 42% and 38% had keratosis pilaris and plantar hyperkeratosis, respectively. Keratosis pilaris is a condition which describes raised red or white bumps typically on the back of the arms, legs, buttocks or cheeks.
This has been linked to problems with essential fatty acid and vitamin A metabolism, dry skin, and genetic anomalies. Keratosis pilaris is also associated with atopic dermatitis and so applying treatments for AD may also help reduce the appearance of keratosis pilaris.
What is Plantar Hyperkeratosis?
Plantar hyperkeratosis is where the stratum corneum (the outermost layer of the epidermis) of the sole of the foot thickens, usually due to excess keratin. This may be due to excessive ingestion of vitamin A or arsenic build-up through chronic exposure (such as from pesticide exposure, environmental pollution, or ingestion of animal fats where arsenic has accumulated).
Low levels of vitamin E have also been found in children with hyperkeratosis and their skin condition has improved with vitamin E and B complex supplementation (Nadiger, 1980).
Number of Skin Tags Associated with Insulin Dysregulation
In this recent study, Gómez and colleagues examined the records of the 109 patients, who had undergone evaluation by a dermatologist, including anthropometry, and had fasting blood glucose and insulin measured. They found statistically significant associations between the degree of obesity and acanthosis nigricans, skin tags, and plantar hyperkeratosis. The number of skin tags, severity of acanthosis nigricans and the distribution of the latter were also significantly and independently associated with insulin levels.
As such, the researchers recommend that physicians view acanthosis nigricans and skin tags as clinical markers of hyperinsulinaemia in nondiabetic patients with obesity.
Managing Blood Sugar Levels
What this means for anyone with these skin conditions is that they may wish to pay close attention to their blood sugar and take steps to improve blood glucose regulation. This is, of course, in addition to consulting a physician to ensure proper management of diabetes and pre-diabetes.
Some basic ways to help the body regulate blood sugar include:
- Getting regular exercise (150 minutes a week, which can be accumulated in short bursts)
- Eliminating simple sugars and refined carbohydrates from the diet
- Choosing healthy whole grain and minimally processed foods
- Ensuring a good intake of soluble and insoluble fibre from fresh fruits, vegetables, whole grains, legumes and pulses
- Choosing healthy monounsaturated and polyunsaturated fats (e.g. olive oil, flaxseed oil, hemp oil)
- Minimising or eliminating animal fats (meat and dairy) that may increase inflammation
- Taking steps to reduce stress and improve stress management (e.g. yoga, mindfulness training, therapy)
- Making use of natural health products that can help with blood glucose regulation
- Losing 5-10% of body weight if obese (this has been shown to have dramatic improvements for blood glucose control).
How Obesity, Skin Tags and Diabetes are Related
Although this study only describes a significant association between markers for skin tags and diabetes, and other skin conditions, there are a few potential mechanisms to explain the apparent connection. Firstly, poor regulation of blood sugar increases levels of systemic inflammation which compromises skin health and may encourage abnormal cell turnover. Adipose tissue produces inflammatory cytokines and so those who are obese and have blood glucose dysregulation are even more likely to have increased levels of inflammation.
Secondly, the same nutrient deficiencies or insufficiencies that are contributing to hyperinsulinaemia may also be at work in the development of skin tags and other skin disorders, such as inadequate essential fatty acid intake, an imbalance in fatty acids leading to increased arachidonic acid derivatives (inflammatory eicosanoids), and poor cell membrane health. Compromised cell membrane function means that the cells do not communicate effectively, which may lead to problematic cell turnover and metabolism.
Abnormal Cell Division in the Skin
Vitamin A is also known to be involved in increased cell division in addition to increasing the skin’s sensitivity to ultraviolet radiation. It may, therefore, affect melanin production and the overgrowth of skin cells. There is also some evidence that people with obesity have dysfunctional gamma delta T-cells which adversely affects the ability of the skin to regulate keratinocyte activity (i.e. the cells that produce keratin run rampant).
Obesity also appears to affect cell to cell adhesion and thereby compromises the skin’s barrier, increasing the risk of infection, wounds, and poor healing. In addition, the simple fact of increased weight and pressure on the feet is likely to lead to plantar hyperkeratosis.
Acanthosis nigricans can also be a feature of polycystic ovary syndrome (PCOS) and is linked to an excess of androgen hormones in cis-women. As insulin resistance is also a feature of PCOS this would provide a common etiology for acanthosis associated with hyperinsulinaemia, diabetes, and obesity.
Taking steps to better regulate blood sugar would also have benefits for optimal hormone clearance and anyone with PCOS would be wise to consult a qualified naturopathic doctor and/or nutritionist for extra guidance on managing their condition.
This study is not the first to note the association between skin conditions, obesity, and insulin dysregulation but it does offer a timely reminder that the appearance of the skin is not simply an indication of skin health. Anyone with skin tags, keratosis pilaris, or plantar hyperkeratosis is advised to consult their physician to determine if they are at risk of diabetes or other systemic disease.
Taylor KR, Costanzo AE, Jameson JM. Dysfunctional gamma delta T cells contribute to impaired keratinocyte homeostasis in mouse models of obesity. J Invest Dermatol. 2011 Dec;131(12):2409-18.
Plascencia Gómez A, Vega Memije ME, Torres Tamayo M, Rodríguez Carreón AA. Skin disorders in overweight and obese patients and their relationship with insulin. Actas Dermosifiliogr. 2014 Mar;105(2):178-85.
H. A. Nadiger. Role of vitamin E in the aetiology of phrynoderma (follicular hyperkeratosis) and its interrelationship with B-complex vitamins. British Journal of Nutrition, 1980, 44:3, pp 211-214.