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Mixed diagnoses – 10 cases (11 of 11)

For each of the ten cases, study the image and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately five minutes to complete. There is a list of suggested further reading material at the end of the quiz.

When you finish the quiz, you can download a certificate.


Case 2

This lady weighs 90 kg. She requests help lightening the colour of her neck.

This is acanthosis nigricans.

The entire skin, but particularly the flexures (groin, axillae) and dorsa of fingers. Look for hyperpigmented velvety plaques and skin tags. Examine for associated systemic diseases.

Acanthosis nigricans is due to insulin resistance.

The commonest associated disorder is obesity. Endocrine associations include diabetes mellitus, hypothyroidism, and polycystic ovaries. Paraneoplastic associations include adenocarcinoma of the stomach, and malignancies of small and large bowel, ovaries, lung, breast and prostate. Drug-induced acanthosis has occurred with nicotinic acid, oestrogens and corticosteroids.

Treatment is disappointing. The acanthosis may remit with successful treatment of underlying disease.

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