Which of the following dermatologic manifestations commonly appears on the posterior neck and flexural folds in patients with diabetes mellitus and insulin resistance?

Appeared in: NORCET-11 Prelims

Explanation

Acanthosis nigricans is characterized by velvety, hyperpigmented, thickened plaques in intertriginous areas, especially the posterior neck and axillae.
It is strongly associated with insulin resistance and diabetes mellitus, serving as a clinical marker for metabolic syndrome.
The pathogenesis involves hyperinsulinemia stimulating growth factor receptors, leading to epidermal proliferation and skin changes.

Option B: Atopic dermatitis typically presents as itchy, red, and inflamed patches, often in flexural areas in children but is not specifically associated with diabetes or insulin resistance.
Option C: Psoriasis presents as well-demarcated, erythematous plaques with silvery scales, commonly on extensor surfaces like elbows and knees, not flexural folds or posterior neck in diabetes.
Option D: Eczema is a general term for inflammatory skin conditions with redness, itching, and scaling, but it does not specifically present as velvety, hyperpigmented plaques in flexural areas related to insulin resistance.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Recognition of dermatologic manifestations associated with diabetes and insulin resistance as background academic context rather than a clinical decision trigger.
Nurses should recognize acanthosis nigricans as a visible marker for insulin resistance and screen for diabetes in affected patients.
Early identification can prompt lifestyle interventions and metabolic evaluation, reducing long-term complications.
What if? If the skin lesion was red, scaly, and on extensor surfaces, psoriasis would be more likely, not acanthosis nigricans.

How to Approach the Question

Identify the clinical scenario: diabetes mellitus and insulin resistance.
Focus on the location: posterior neck and flexural folds.
Recall the classic skin findings associated with metabolic syndrome.
Eliminate options that do not match the described distribution or association with diabetes.
Select the answer that best fits the clinical and anatomical clues.

Concept Tested & Keywords

Concept Tested: Recognition of dermatologic manifestations associated with diabetes and insulin resistance
Stem keywords: dermatologic manifestations, posterior neck, flexural folds, diabetes mellitus, insulin resistance
Lead-in keywords: commonly appears
Clinical cues: Posterior neck and flexural folds are classic sites for acanthosis nigricans in diabetes

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1919-1921

E6 Gynecology Williams p. 99-128

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 1142-1144

Practise the full NORCET-11 Prelims

Attempt every question from this paper in a timed mock, then review the full solution for each one.