Acanthosis Nigricans : Causes-Symptoms-Diagnosis-Treatment
What are Acanthosis Nigricans?
Acanthosis nigricans is a skin condition in which a velvety papillomatous overgrowth of the epidermis occurs. This leads to darkening and thickening (hyperkeratosis) of the skin mainly in the flexural areas, such as the axillae groins, inframammary regions, and the neck.
Acanthosis nigricans is usually a sign of an underlying condition or disease, such as obesity or diabetes (benign). However, its presence as a sign of internal cancer is very rare.
Medical terms
Acanthosis nigricans is a skin condition characterized by the thickening and darkening of certain areas of the skin, typically in the folds and creases of the body. It often appears as velvety, brown to black patches or streaks of skin that feel rough to the touch. The most common areas affected by acanthosis nigricans include the:
Neck
Armpits
Groin
Elbows
Knees
Knuckles
Acanthosis nigricans is not a disease in itself but rather a symptom or a sign of an underlying medical condition. It can be associated with various factors, including:
Insulin Resistance: One of the most common causes of acanthosis nigricans is insulin resistance, which is often associated with type 2 diabetes or prediabetes. When the body becomes resistant to insulin, it can lead to increased insulin levels in the blood, which may contribute to skin changes.
Obesity: Acanthosis nigricans is more prevalent in overweight individuals, especially those with a high body mass index (BMI).
Hormonal Disorders: Hormonal disorders such as polycystic ovary syndrome (PCOS) and thyroid disorders can sometimes be linked to acanthosis nigricans.
Medications: Some medications, particularly corticosteroids and oral contraceptives, can lead to skin changes like acanthosis nigricans in some individuals.
Genetic Factors: In rare cases, acanthosis nigricans can be hereditary, passed down through families.
Malignancies: Although less common, acanthosis nigricans can sometimes be associated with certain cancers, particularly stomach and liver cancers.
It's important to note that acanthosis nigricans itself is benign and not harmful. However, it serves as a visual indicator that there may be an underlying medical issue that requires evaluation and treatment. If you or someone you know develops acanthosis nigricans, it's essential to consult a healthcare provider to determine the underlying cause and address any associated health concerns, such as diabetes or hormonal imbalances. The treatment approach will depend on the specific underlying condition identified.
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Acanthosis nigricans in children
Acanthosis Nigricans is the name for a skin condition in which spots appear in various places on the body including folds of the skin such as the neck, groin, underarms and around the breast. The spots can also be found across joints or flexed areas where there is increased friction. They begin as brown spots but get darker and larger over time. . It is more common in people who have diabetes. Obesity is another factor that increases the risk of developing this rash. But most of the time these rashes do not pose a threat to your health.
Causes Acanthosis nigricans
The exact cause is still unknown, but it is primarily connected to states of insulin resistance where obesity, diabetes, or other metabolic disorders (for example, metabolic syndrome, polycystic ovary syndrome, generalized lipodystrophy) coexist.
Insulin crosses the skin-epidermis boundary and in high concentrations can have growth-stimulating effects by binding to type 1 insulin-like growth factor receptors (IGFRs) on keratinocytes. This stimulates the proliferation of these cells, leading to Acanthosis Nigricans.
Other rarer benign types include:
Drug-induced acanthosis nigricans:
Associated drugs include (but are not limited to) topical medications such as nicotinic acid lotion, fusidic acid ointment, oral contraceptives, oral corticosteroids, hormones (such as diethylstilbestrol or testosterone), and triazine and aripiprazole.
Hereditary benign acanthosis nigricans:
This condition is a rare autosomal dominant disorder that starts during early childhood and progresses until puberty. It is caused by a mutation in the fibroblast growth factor receptor 3.
Autoimmune acanthosis nigricans:
Some conditions are associated with olive oil, such as systemic lupus erythematosus, Sjögren syndrome, and Hashimoto's thyroiditis.
Acral acanthotic anomaly:
This condition typically occurs in darker skin types and is limited to the elbows, knees, and dorsal aspects of the hands and feet.
Unilateral acanthosis nigricans:
Naevoid acanthosis nigricans is a rare autosomal dominant skin disorder that causes lesions to occur on one side of the body along Blaschko lines. It can show up in infancy, childhood, or adulthood.
Rare malignant nigricans is:
The growth of tumors may be due to the release of stimulatory growth factors.
Gastric cancer is typically caused by a disease in the stomach.
Other types of cancers include liver cancer, squamous cell carcinoma, malignant melanoma, and Wilms tumor.
Oral cavity involvement is common in cases of cancer.
Tripe palms are a variant with a high association with cancer.
Symptoms of acanthosis nigricans
Patches of thick, brown skin will develop symmetrically on the skin. These patches may also form plaques.
In the intertriginous areas (the areas between the arms and legs, on the inside of the thighs, and on the back of the neck), most people get patches.
On women's nipples and between their vaginal and perineal areas areola areola (nipples), vulva (vagina), and perineum
Malignant acanthosis nigricans often affect the oral cavity, nasal and laryngeal mucosa, and esophagus. These areas are usually more affected in size and severity than other parts of the body.
Skin tags are common on skin and mucous surfaces.
If lesions grow, they may become macerated (covered in bacteria) or malodorous (smelly).
Malignant acanthosis nigricans may cause itching.
Diagnosis Acanthosis Nigricans
Acanthosis nigricans may be detected at some stage in a pores and skin examination. To be sure of the analysis, your fitness care company might take a skin pattern (biopsy) to examine below a microscope. Or you could want different tests to discover what is inflicting your signs.
Treatment Acanthosis Nigricans
There's no specific remedy for acanthosis nigricans. Your care issuer might propose remedies to help with pain and smell, along with pores and skin lotions, special soaps, medicinal drugs and laser remedy.
Treating the underlying motive may help. Examples consist of:
Lose weight. If your acanthosis nigricans are caused by weight problems, dietary counseling and losing weight may assist.
Stop medications. If your circumstance appears to be associated with a medication or complement which you use, your care issuer may advocate that you stop using that substance.
Have surgical operation. If acanthosis nigricans was brought on by using a cancerous tumor, surgical operation to remove the tumor regularly clears up the pores and skin signs and symptoms.
Preparing for your appointment
You're likely to start by seeing your family doctor. He or she may refer you to a doctor who specializes in skin disorders (dermatologist) or hormone problems (endocrinologist). Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well-prepared for your appointment.
General measures
Non-medical treatment includes modifying one's lifestyle, such as eating a healthy diet and exercising to help attenuate insulin resistance and hyperinsulinemia.
Metformin and rosiglitazone have been used to lower insulin levels and improve the lesions.
Malignant acanthosis nigricans should be treated with care so that the cancer can be diagnosed and managed. Cyproheptadine can help reduce the symptoms of acanthosis nigricans that are caused by the cancer, since it inhibits the release of tumor-produced substances.
If you believe that your child is taking a drug that may be causing their skin to become darkened and thick, you can try to discontinue using the drug and see if that resolves the issue.
Treatment of an underlying syndrome can improve syndromic acanthosis nigricans (SAN). For example, using oral contraceptives to treat polycystic ovary syndrome.
Specific measures
Treating acanthosis nigricans lesions can also be done for cosmetic reasons. Pharmacological treatments can include:
Keratolytic agents: salicylic acid, glycolic acid, or trichloroacetic acid
Topical retinoids: adapalene gel or tretinoin cream can be used to treat acne.
Calcipotriol
Omega 3 fatty acids (fish oil)
Podophyllin
Procedural modalities include:
Psoralen plus UVA (PUVA)
Dermabrasion
Long-pulsed alexandrite laser therapy.
What you can do
Before your appointment, you may want to list answers to the following questions:
Has anyone in your family ever had this problem?
Does diabetes run in your family?
Have you ever had problems with your ovaries, adrenal glands or thyroid?
What medications and supplements do you take on a regular basis?
Have you ever had to take high doses of prednisone for more than a week?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
When did your symptoms begin?
Have they gotten worse?
What areas of your body are affected?
Have you ever had cancer?
General summary
It's important to note that the presence of acanthosis nigricans should prompt a healthcare professional to investigate and determine the underlying cause. If you or someone you know has acanthosis nigricans, it's advisable to consult a healthcare provider to evaluate the potential underlying conditions and develop an appropriate treatment plan. Addressing the underlying cause, such as managing insulin resistance or obesity, is often the primary approach to managing acanthosis nigricans.
