Hyperinsulinemia associated with acanthosis nigricans, finger pebbles, acrochordons, and the sign of Leser-Trélat.

OBJECTIVE: To review common skin manifestations associated with type 2 diabetes mellitus (DM), and to discuss a potential underlying mechanism for these manifestations.

METHODS: A PubMed literature search was conducted for articles describing the skin manifestations associated with hyperinsulinemia and type 2 DM. A case presentation describes a morbidly obese patient with type 2 DM treated with metformin who developed acanthosis nigricans, finger pebbles, scores of skin tags (acrochordons), and the sign of Leser-Trélat (sudden onset shower of seborrheic keratoses) in the absence of internal malignancy.

RESULTS: Acanthosis nigricans, acrochordons, and finger pebbles have been associated with type 2 DM and obesity. While the Leser-Trélat sign is classically associated with internal malignancy, it can also be idiopathic. To our knowledge, this the first report of the occurrence of the Leser-Trélat sign in a patient with DM absent internal malignancy.

CONCLUSION: Several skin manifestations can be seen in this patient with DM because of underlying insulin resistance and subsequent stimulation of insulin-like growth factor receptors. Management strategies could include weight loss, diet, and insulin-sensitizing pharmacologic therapy.