Insulin Resistance: a cause of worry for pre-diabetic / diabetic patients

In the present era of having diet fads and eating excessive junk foods, lack of physical activity, stressful life, we have been observing an increased incidence of various lifestyle disorders like obesity , metabolic syndrome, PCOS in all age groups. One such condition of major concern to not only physicians but dermatologists as well is insulin resistance which is a predictor for pre-diabetic / diabetic state.

When a patient walks in for a consultation with signs such as dark coarse thick skin usually seen on face especially on cheek and forehead, neck, or on examination similar signs on axillae, groin(all body creases) we clinically think in terms of 'Acanthosis nigricans' due to insulin resistance.

Now when the test results are in, they panic saying they are not diabetic or they do not want medication for diabetes or even not ready to accept that they are in a pre-diabetic state. Counselling the patients regarding insulin resistance is of utmost importance. The task gets tougher in the pediatric and younger age group.

Management we offer to these patients focuses on treating insulin resistance as a systemic condition, rather than a localised approach to acanthosis nigricans in isolation. 

Do not assume that the dark thick skin is dirt and try to scrub or rub or go for parlour activities which will only worsen the pigmentation.

To summarise, insulin resistance is a lifestyle condition with an increasing incidence with acanthosis nigricans being one of its preliminary markers which should be approached as a systemic condition and not just for its cosmetic disfigurement. Treatment options differ from person to person depending on coexisting conditions; however the above options hold good in most of the situations. Results not only depend on the treatment we offer but also on the level of motivation and patient effort.