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Tuesday, September 9, 2025

Acanthosis Nigricans


Acanthosis Nigricans

Overview

Acanthosis nigricans (AN) is a skin condition characterized by hyperpigmented, thickened, velvety plaques typically found on the neck, axillae, groin, and other skin folds.

It is not a disease itself but a cutaneous marker of underlying systemic conditions, such as:

  • Insulin resistance (type 2 diabetes, obesity, metabolic syndrome).

  • Endocrine disorders (Cushing’s syndrome, hypothyroidism, polycystic ovary syndrome).

  • Drug-induced (glucocorticoids, high-dose niacin, insulin, oral contraceptives).

  • Malignancy-associated (paraneoplastic) – especially gastric adenocarcinoma in older patients with sudden onset and rapid progression.

Treatment Options

1. Treat Underlying Cause

  • Insulin resistance / Type 2 diabetes:

    • Metformin: Start 500 mg PO daily, increase to 1000 mg BID as tolerated.

    • Lifestyle modification: weight loss, diet control, exercise.

  • PCOS-related: hormonal regulation (OCPs, metformin).

  • Drug-induced: discontinue offending drug if possible.

  • Malignancy-associated: treat underlying cancer.

2. Dermatological Therapies (Symptomatic Relief)

  • Topical keratolytics / depigmenting agents:

    • Tretinoin 0.05–0.1% cream nightly.

    • Hydroquinone 4% cream once daily.

    • Salicylic acid 6% ointment daily.

  • Topical vitamin D analogs:

    • Calcipotriol 0.005% cream once or twice daily.

  • Oral retinoids (severe, refractory cases):

    • Isotretinoin 0.5–1 mg/kg/day PO.

  • Laser therapy (Nd:YAG, fractional CO₂ laser): improves cosmetic appearance in resistant cases.

3. Supportive & Adjunctive Care

  • Gentle skin hygiene (avoid friction, keep folds dry).

  • Emollients: urea 10–20% creams or ammonium lactate 12% lotion.

  • Psychological support for cosmetic distress, especially in adolescents.

Key Notes

  • Acanthosis nigricans is a clinical sign, not a diagnosis. Always search for underlying systemic disease.

  • In obese children/adolescents, it strongly predicts insulin resistance and risk of type 2 diabetes.

  • Sudden onset, severe, or extensive AN in adults should raise suspicion for malignancy.

  • Management is most effective when underlying cause is addressed; dermatological therapy mainly improves cosmetic appearance.



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