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I read the short report by MA Crook on “Skin tags and the atherogenic lipid profile”1 with interest. Multiple skin tags are frequently found in patients with acromegaly and may predict colonic polyps.2 Hypersecretion of growth hormone induces insulin resistance, with glucose intolerance occurring in 29–45% and clinical diabetes mellitus in 10–20% of cases. Hypertriglyceridaemia occurs in 19–44% of patients with acromegaly and is probably the result of decreased hepatic triglyceride lipase and lipoprotein lipase activities3 because the activities of these enzymes rise after successful lowering of growth hormone values. Could increased growth hormone concentrations be the link between skin tags, insulin resistance, and the atherogenic lipid profile in these four cases?
I was very interested in Dr Twomey's letter suggesting that growth hormone may be a possible link between skin tags and the atherogenic lipid profile. Unfortunately, we do not have growth hormone determinations in our patients so we are unable to test his hypothesis, although presumably it would not be too difficult to design such studies. The cutaneous manifestations of lipid disorders are relatively unexplained and unexplored. Why—for example, do xanthelasma or eruptive xanthoma appear at certain sites and not in every patient with lipid abnormalities? Interestingly, one of the patients in our study who had an atherogenic lipid profile also manifested bilateral ear lobe creases. The importance of this is unclear and also merits further study, particularly because these are thought to be associated with cardiovascular disease.1–3