Obese people may have several disorders of the skin. The most common is stasis changes of the skin of the lower legs in massively obese people. The etiology of this finding is venous stasis, edema, and breakdown of the skin. Fragilitas cutis inguinalis is a condition of fragile skin in the inguinal area of obese people. This condition is diagnosed by stretching the skin of the inguinal area. A linear tear appears at right angles to an applied force that is insufficient to tear the skin of a normal person. This condition is unrelated to the sex and age of the person.

Acanthosis nigricans, seen occasionally in obesity, is characterized by darkening of the skin in the creases of the neck, axillary regions, and over the knuckles. An association between acanthosis nigri-cans and insulin resistance is reported in people who have circulating antibodies to the insulin receptors. Since acanthosis nigricans also may be associated with highly malignant cancers such as intraabdominal adenocarcinomas, physicians should be alert to this possibility and not attribute the condition simply to the presence of obesity.

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