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I appreciate the comments of Dr Khardori and find that I am basically in agreement with him.Inasmuch as the patient discussed had both acanthosis nigricans and insulin resistance while hypothyroid and a resolution of these abnormalities after thyroid hormone replacement, I do not believe that the title of the article is misleading; the acanthosis and insulin resistance were, in fact, associated with hypothyroidism. Dr Khardori's point seems to be that the hypothyroidism was not the immediate cause of the acanthosis nigricans but instead promoted obesity and subsequent insulin resistance, which, in turn, led to the acanthosis. I agree with this entirely. The major point of my article was that hyperinsulinemia may be the final common denominator for a number of apparently diverse endocrine disorders that are associated with acanthosis nigricans. This concept was very nicely reviewed in Dr Flier's accompanying editorial.I share Dr Khardori's hope that
Ober KP. Hypothyroidism, Insulin Resistance, and Acanthosis Nigricans-Reply. Arch Dermatol. 1985;121(8):967-968. doi:10.1001/archderm.1985.01660080021004