Metabolic syndrome (MetS) is a multifactorial condition defined by the coexistence of central obesity, insulin resistance, hypertension, dyslipidemia, and impaired glucose tolerance. Its prevalence has been rising worldwide, largely driven by urbanization, sedentary behavior, and dietary transitions, especially in developing countries [1]. MetS is widely recognized as a precursor to type 2 diabetes mellitus and cardiovascular disease, thereby contributing significantly to global morbidity and mortality [1,2]. Dermatological manifestations are increasingly acknowledged as early or concomitant indicators of MetS, providing important clinical cues for timely diagnosis. Common cutaneous markers such as acanthosis nigricans, skin tags, and xanthelasma are closely associated with obesity, hyperinsulinemia, and dyslipidemia [1,2]. Moreover, chronic inflammatory dermatoses including psoriasis and lichen planus have been linked to MetS through shared pathogenic mechanisms involving insulin resistance, oxidative stress, and pro-inflammatory cytokines [3,4]. These associations emphasize the bidirectional relationship between skin and systemic health, underlining the relevance of dermatological findings as predictors of cardiometabolic risk [2,4]. Recent studies have also highlighted the evolving therapeutic perspective, wherein management of metabolic risk factors may positively influence the course of associated dermatoses, and vice versa [5]. Despite this growing body of evidence, limited research from India has comprehensively examined the dermatological spectrum in patients with MetS. Given the interplay of ethnic, genetic, and lifestyle determinants, region-specific studies are essential to strengthen early recognition strategies and guide preventive care. Aim: The present study was undertaken to evaluate the clinical profile of dermatological manifestations among patients with metabolic syndrome and to explore their association with individual components of the syndrome.

Study Design and Setting: This was a hospital-based, cross-sectional observational study conducted in the Department of Dermatology, Venereology and Leprosy (DVL), Government Medical College and Government General Hospital, Rajanna Siricilla, Telangana, over a period of six months from January 2025 to June 2025. Study Population: A total of 100 patients diagnosed with metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria were recruited. Patients aged between 30 and 70 years of either gender attending the dermatology outpatient department were considered eligible. Inclusion Criteria: Patients fulfilling at least three of the following ATP III criteria: Central obesity (waist circumference >90 cm in men and >80 cm in women for South Asians) Hypertriglyceridemia (≥150 mg/dL) Low HDL cholesterol (<40 mg/dL in men, <50 mg/dL in women) Hypertension (≥130/85 mmHg or on antihypertensive treatment) Fasting plasma glucose ≥100 mg/dL or known diabetes mellitus Willingness to provide informed consent. Exclusion Criteria: Patients with systemic illnesses other than metabolic syndrome that could independently produce dermatological manifestations (e.g., thyroid disease, chronic renal failure). Pregnant or lactating women. Patients unwilling to participate. Data Collection: A predesigned proforma was used to record demographic details, medical history, and clinical parameters. Anthropometric measurements (height, weight, BMI, waist circumference, blood pressure) and relevant biochemical investigations (fasting glucose, lipid profile) were documented. All participants underwent a detailed dermatological examination by qualified dermatologists. Cutaneous findings were systematically classified and recorded. Statistical Analysis: Data were entered into Microsoft Excel and analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Results were expressed as frequencies and percentages for categorical variables and mean ± standard deviation for continuous variables. Associations between dermatological findings and metabolic syndrome components were tested using Chi-square or Fisher’s exact test. A p-value <0.05 was considered statistically significant. Ethical Considerations: The study was approved by the Institutional Ethics Committee of Government Medical College, Rajanna Siricilla. Written informed consent was obtained from all participants prior to enrollment.

A total of 100 patients with metabolic syndrome were included in the present study. The mean age of the participants was 49.6 ± 10.8 years, with the majority falling in the 41–60 year age group. Males constituted 58% of the study population, while females accounted for 42% (Table 1). Table 1. Demographic Profile of Study Participants (n = 100) Variable Category Frequency Percentage (%) Age (years) 30–40 18 18% 41–50 32 32% 51–60 30 30% >60 20 20% Gender Male 58 58% Female 42 42% Mean Age 49.6 ± 10.8 years — — Dermatological manifestations were diverse, with acanthosis nigricans (48%) being the most prevalent, followed by skin tags (41%), xanthelasma palpebrarum (12%), and psoriasis (10%). Other findings such as seborrheic keratosis, palmoplantar hyperkeratosis, ichthyosis vulgaris, alopecia androgenetica, urticaria, and lichen planus were observed less frequently (Table 2). Table 2. Distribution of Dermatological Manifestations Dermatological Manifestation Frequency Percentage (%) Acanthosis nigricans 48 48% Skin tags (Acrochordons) 41 41% Xanthelasma palpebrarum 12 12% Psoriasis 10 10% Seborrheic keratosis 8 8% Palmoplantar hyperkeratosis 6 6% Ichthyosis vulgaris 4 4% Alopecia androgenetica 3 3% Urticaria 2 2% Lichen planus 2 2% On analyzing the relationship between obesity and dermatological findings, a statistically significant association was noted between acanthosis nigricans and obesity (p < 0.05). While skin tags, psoriasis, and xanthelasma were more common among obese individuals, the associations were not statistically significant (Table 3). Table 3. Association between Obesity (BMI ≥ 30 kg/m²) and Dermatological Findings Dermatological Finding Present in Obese Patients (n=60) Present in Non-obese Patients (n=40) p-value Acanthosis nigricans 38 (63.3%) 10 (25%) <0.05* Skin tags 28 (46.7%) 13 (32.5%) 0.12 Psoriasis 7 (11.7%) 3 (7.5%) 0.41 Xanthelasma 9 (15%) 3 (7.5%) 0.29 *Significant association observed between obesity and acanthosis nigricans. When evaluated in relation to individual components of metabolic syndrome, central obesity was most frequently associated with acanthosis nigricans (70%), while hypertriglyceridemia and low HDL cholesterol correlated with skin tags and xanthelasma (45% and 10%, respectively). Psoriasis and seborrheic keratosis were more often seen in hypertensive patients (12%), whereas patients with impaired fasting glucose or diabetes predominantly exhibited acanthosis nigricans and psoriasis (22%) (Table 4). Table 4. Dermatological Manifestations in Relation to Metabolic Syndrome Components Component of Metabolic Syndrome Most Associated Dermatological Finding Frequency (%) Central obesity (waist circumference > cutoff) Acanthosis nigricans 70% Hypertriglyceridemia Skin tags, Xanthelasma 45% Low HDL cholesterol Xanthelasma 10% Hypertension Psoriasis, Seborrheic keratosis 12% Impaired fasting glucose / Diabetes Acanthosis nigricans, Psoriasis 22%

The present study demonstrates a wide spectrum of dermatological manifestations among patients with metabolic syndrome, reaffirming the critical role of the skin as a marker of underlying systemic pathology. Among the 100 participants, acanthosis nigricans (48%) was the most prevalent cutaneous finding, followed by skin tags (41%) and xanthelasma palpebrarum (12%). These results parallel earlier observations where acanthosis nigricans and acrochordons were consistently linked with obesity, hyperinsulinemia, and insulin resistance, underscoring their value as easily identifiable clinical indicators of metabolic dysfunction [1,2,6]. The significant association between obesity and acanthosis nigricans in this study reinforces its reliability as a surrogate marker for insulin resistance and early metabolic derangement. In addition, psoriasis was observed in 10% of cases, aligning with the established recognition of psoriasis as a systemic inflammatory disease frequently associated with metabolic syndrome [3,7]. Shared inflammatory mediators, including tumor necrosis factor-α, interleukin-6, and oxidative stress, contribute to both metabolic and cutaneous pathology, suggesting a bidirectional relationship. A recent meta-analysis further supported the association between psoriasis and metabolic syndrome, highlighting its implications for long-term cardiometabolic outcomes [8,12]. Similarly, the presence of lichen planus (2%) in our cohort resonates with existing evidence linking it to dyslipidemia, endothelial dysfunction, and an increased risk of cardiovascular disease [4,9]. The occurrence of xanthelasma palpebrarum (12%), predominantly in patients with lipid abnormalities, reflects the established association of this manifestation with atherogenic dyslipidemia. Earlier Indian studies have also underscored xanthelasma as a visible cutaneous sign of systemic lipid derangements [5,10]. Moreover, the coexistence of multiple dermatological manifestations in some individuals highlights the compounded effect of metabolic risk factors on the skin, consistent with prior reports documenting overlapping cutaneous presentations in metabolic syndrome [6,11]. Importantly, gender-specific patterns have also been reported, with women more likely to develop certain dermatological conditions related to metabolic risk [11]. This observation emphasizes the need for tailored clinical screening, particularly in populations where both metabolic syndrome and dermatological disorders are highly prevalent. Furthermore, the integration of dermatological assessment into routine evaluation of metabolic syndrome has been advocated as part of a broader preventive strategy, given that recognition of skin markers can facilitate earlier diagnosis and intervention [7,8]. Overall, our findings, in line with recent literature [6–12], emphasize the significance of dermatological evaluation in patients with metabolic syndrome. Early identification of skin changes not only aids in diagnosing underlying metabolic disturbances but also offers opportunities for timely lifestyle modification, pharmacological intervention, and long-term cardiovascular risk reduction. Limitations: The study was limited by its relatively small sample size and single-center design, which may restrict generalizability. Additionally, histopathological confirmation was not pursued for all cases, as clinical diagnosis sufficed in the majority. Implications: Despite these limitations, the study underscores the importance of routine dermatological evaluation in patients with metabolic syndrome. Cutaneous markers such as acanthosis nigricans and skin tags should prompt clinicians to screen for metabolic abnormalities, thereby reducing long-term cardiometabolic morbidity.

This study demonstrates that dermatological manifestations are frequent and clinically significant in patients with metabolic syndrome. Acanthosis nigricans and skin tags were the most common findings, strongly associated with obesity and dyslipidemia, while psoriasis and xanthelasma highlighted the role of systemic inflammation and lipid abnormalities. Recognition of such cutaneous markers is crucial, as they may serve as early indicators of underlying metabolic risk, enabling timely intervention and prevention of cardiovascular complications. Although limited by single-center design and modest sample size, the study emphasizes the need for interdisciplinary collaboration, with dermatologists playing a pivotal role in the early detection of metabolic syndrome.

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