*2.4.1 Mechanical causes of dermatologic manifestations associated with obesity*

Striae or stretch marks are a type of scarring of the dermis associated with stretching of the dermis. Striae distensae may appear as a consequence of pregnancy, puberty, or obesity and appear on abdomen, breasts (in females), and shoulders (in body builders). They are more common in females [38]. Striae atrophicans due to thinning of the skin may appear in adrenal gland disorders [39].

Other dermatological conditions with mechanical causes include intertrigo, conditions associated with chronic venous insufficiency, and lymphedema [40]. Intertrigo

### **Figure 4.**

*Dermatological manifestations associated with obesity.*

is an inflammation of skin resulting from friction between opposing skin surfaces of skin folds. It may have an infectious component. Axilla, groin, intergluteal, and inframammary areas may be involved [41]. Hot, humid climates and obesity (BMI > 30 kg/m2 ) are known to promote intertrigo. Persons with obesity tend to sweat more.

Dermatologic sequelae of chronic venous insufficiency (discussed above) are often seen in patients with obesity and include pitting edema, varicose veins, telangiectasia, hyperpigmentation, venous stasis ulcers, and scaling of the skin (stasis dermatitis) [42].

Blocking or damage of the lymphatic system resulting in accumulation of lymph in soft tissues, especially legs or arms, is called lymphedema. Obesity is a risk factor for secondary lymphedema [40].

### *2.4.2 Obesity-related endocrine disorders of skin*

These include skin tags, acanthosis nigricans, keratosis pilaris, hidradenitis suppurativa and hirsutism, and plantar hyperkeratosis.


axilla, breasts) [51]. It affects about 1% of the population and is strongly associated with smoking and obesity. It is also linked with hyperandrogenemia, as many patients have acne and hirsutism [52].

