A.R. Shipman; G.W.M. Millington


The British Journal of Dermatology. 2011;165(4):743-750. 

In This Article

Obesity and Rarer Skin Conditions

Obesity is linked with a number of rarer conditions. Keratosis follicularis squamosa is a condition consisting of scaly patches, symmetrically scattered over the trunk, buttocks and thighs.[121] Histopathological examination shows a dilated hair follicle with a follicular plug, surrounded by lamellar orthohyperkeratosis.[121] There may be an association with obesity.[121]

Granular parakeratosis is a recently recognized disorder of keratinization that is confined to intertriginous body sites, which may explain the connection with obesity.[122] The histological features are distinctive: a parakeratotic stratum corneum, with the presence of keratohyaline granules.[122] These granules are normally confined to the stratum granulosum.[122] The underlying pathophysiological defect is thought to be a failure in the normal degradation of profilaggrin and it is responsive to topical corticosteroids.[122]

Pretibial mucin deposition on the shins, in association with autoimmune thyroid disease, is known as pretibial myxoedema.[123] A similar condition (both clinically and histologically), in the absence of thyroid disease, is described in two case series of morbidly obese patients.[124,125] These papers proposed a new entity, chronic obesity lymphoedematous mucinosis, as a subtype of pretibial myxoedema.[124,125]

Polymorphic eruption of pregnancy is a self-limiting pruritic urticarial disorder of pregnancy, which starts in the last trimester or immediately postpartum.[126] Risk factors include primiparous women with excessive maternal weight gain, as well as multiple pregnancies.[126]

Dercum's disease (adiposis dolorosa) is a rare disease characterized by multiple, painful, subcutaneous lipomata that usually occur in obese, postmenopausal women.[127] It may have a familial basis.[128]

Keratoderma climacterum usually occurs in postmenopausal women, with no personal or family history of skin disorders.[128] There is a strong association with obesity.[129] The hyperkeratosis develops first at plantar pressure points and then the hyperkeratosis extends along the sole of the foot, with erythema and fissuring, making walking painful.[129] Acitretin orally can reduce the symptoms.[129]


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