Acanthosis Nigricans Treatment & Management

  • Author: Jason H Miller, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 15, 2010
 

Medical Care

No treatment of choice exists for acanthosis nigricans (AN). The goal of therapy is to correct the underlying disease process. Treatment of the lesions of acanthosis nigricans is for cosmetic reasons only. Correction of hyperinsulinemia often reduces the burden of hyperkeratotic lesions. Likewise, weight reduction in obesity-associated acanthosis nigricans may result in resolution of the dermatosis.

Note the following:

  • Cessation of inciting agent in drug-induced acanthosis nigricans often results in resolution. Acipimox may be used in place of nicotinic acid to induce acanthosis nigricans regression while improving the lipid profile.[18] Dietary fish oil reportedly is beneficial in patients with lipodystrophic diabetes and generalized acanthosis nigricans, even if niacin is continued.[19]
  • Topical medications that have been effective in some cases of acanthosis nigricans include keratolytics (eg, topical tretinoin 0.05%, ammonium lactate 12% cream, or a combination of the 2) and triple-combination depigmenting cream (tretinoin 0.05%, hydroquinone 4%, fluocinolone acetonide 0.01%) nightly with daily sunscreen.[20] Calcipotriol, podophyllin, urea, and salicylic acid also have been reported, with variable results.[1]
  • Oral agents that have shown some benefit include etretinate,[21] isotretinoin,[22] metformin,[23] and dietary fish oils.[24] Octreotide showed sustained improvement in one patient with insulin resistance 6 months after completing the course.[25]
  • Hyperandrogenemia, insulin resistance, and acanthosis nigricans syndrome (HAIR-AN syndrome) patients may be treated with oral contraceptives and metformin.[1]
  • Dermabrasion and long-pulsed alexandrite laser therapy may also be used to reduce the bulk of the lesion, with some long-term remission.[26]
  • Surgical removal of tumors is the mainstay of treatment for malignant acanthosis nigricans, if possible, because clearance following primary malignancy excision has been reported.[27]
  • Cyproheptadine has been used in cases of malignant acanthosis nigricans because it may inhibit the release of tumor products.[28]
  • Psoralen plus UVA (PUVA) has been reported as beneficial for symptomatic relief in cases of paraneoplastic acanthosis nigricans.[5]
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Surgical Care

Dermabrasion and long-pulsed alexandrite laser therapy may also be used to reduce the bulk of the lesion, with some long-term remission.[29]

Surgical removal of tumors is the mainstay of treatment for malignant acanthosis nigricans, if possible, because clearance following primary malignancy excision has been described.[27]

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Consultations

Based on underlying etiology, multidisciplinary evaluation may include the following:

  • Primary care physician (pediatrician, internist, or family practitioner)
  • Endocrinologist
  • Oncologist
  • Geneticist
  • Dermatologist
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Diet

Weight loss and glycemic control are essential for those with obesity-related acanthosis nigricans or hyperinsulinemic states.

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Contributor Information and Disclosures
Author

Jason H Miller, MD  Private Practice, Hametz and Picascia Dermatology Associates, Freehold, New Jersey

Jason H Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Ronald P Rapini, MD  Josey Professor and Chair, Department of Dermatology, Professor of Pathology, University of Texas Medical School at Houston and MD Anderson Cancer Center

Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Society for Investigative Dermatology, and Texas Medical Association

Disclosure: Elsevier publishers Royalty Independent contractor

Specialty Editor Board

Ponciano D Cruz Jr, MD  Vice-Chair, JB Shelmire Professor, Department of Dermatology, University of Texas Southwestern Medical Center

Ponciano D Cruz Jr, MD is a member of the following medical societies: Texas Medical Association

Disclosure: RCTS Consulting fee Independent contractor; Mary Kay Cosmetics Honoraria Consulting; Galderma Grant/research funds Principal Investigator

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Edward F Chan, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Jonathan Baron, MD, and Norman Levine, MD, to the development and writing of this article.

References

  1. Sinha S, Schwartz RA. Juvenile acanthosis nigricans. J Am Acad Dermatol. Sep 2007;57(3):502-8. [Medline].

  2. Higgins SP, Freemark M, Prose NS. Acanthosis nigricans: a practical approach to evaluation and management. Dermatol Online J. Sep 15 2008;14(9):2. [Medline].

  3. Berk DR, Spector EB, Bayliss SJ. Familial acanthosis nigricans due to K650T FGFR3 mutation. Arch Dermatol. Sep 2007;143(9):1153-6. [Medline].

  4. Sharda S, Panigrahi I, Gupta K, Singhi S, Kumar R. A newborn with acanthosis nigricans: can it be Crouzon syndrome with acanthosis nigricans?. Pediatr Dermatol. Jan 1 2010;27(1):43-7. [Medline].

  5. Krawczyk M, Mykala-Ciesla J, Kolodziej-Jaskula A. Acanthosis nigricans as a paraneoplastic syndrome. Case reports and review of literature. Pol Arch Med Wewn. Mar 2009;119(3):180-3. [Medline].

  6. Mailler-Savage EA, Adams BB. Exogenous insulin-derived Acanthosis nigricans. Arch Dermatol. Jan 2008;144(1):126-7. [Medline].

  7. Lane SW, Manoharan S, Mollee PN. Palifermin-induced acanthosis nigricans. Intern Med J. Jun 2007;37(6):417-8. [Medline].

  8. Wu JC, Cunningham BB. Ectopic acanthosis nigricans occurring in a child after syndactyly repair. Cutis. Jan 2008;81(1):22-4. [Medline].

  9. Sadeghian G, Ziaie H, Amini M, Ali Nilfroushzadeh M. Evaluation of insulin resistance in obese women with and without acanthosis nigricans. J Dermatol. Apr 2009;36(4):209-12. [Medline].

  10. Scott AT, Metzig AM, Hames RK, Schwarzenberg SJ, Dengel DR, Biltz GR. Acanthosis nigricans and oral glucose tolerance in obese children. Clin Pediatr (Phila). Jan 2010;49(1):69-71. [Medline].

  11. Brickman WJ, Huang J, Silverman BL, Metzger BE. Acanthosis nigricans identifies youth at high risk for metabolic abnormalities. J Pediatr. Jan 2010;156(1):87-92. [Medline].

  12. Stoddart ML, Blevins KS, Lee ET, Wang W, Blackett PR. Association of acanthosis nigricans with hyperinsulinemia compared with other selected risk factors for type 2 diabetes in Cherokee Indians: the Cherokee Diabetes Study. Diabetes Care. Jun 2002;25(6):1009-14. [Medline].

  13. Brickman WJ, Binns HJ, Jovanovic BD, Kolesky S, Mancini AJ, Metzger BE. Acanthosis nigricans: a common finding in overweight youth. Pediatr Dermatol. Nov-Dec 2007;24(6):601-6. [Medline].

  14. Otto DE, Wang X, Tijerina SL, Reyna ME, Farooqi MI, Shelton ML. A Comparison of Blood Pressure, Body Mass Index, and Acanthosis Nigricans in School-Age Children. J Sch Nurs. Mar 24 2010;[Medline].

  15. Daitchman J, Vermeulen MJ, Ray JG. Acanthosis nigricans among women with gestational diabetes mellitus and risk of adverse pregnancy outcomes. Diabetes Care. May 2008;31(5):e30. [Medline].

  16. Ice CL, Murphy E, Minor VE, Neal WA. Metabolic syndrome in fifth grade children with acanthosis nigricans: results from the CARDIAC project. World J Pediatr. Feb 2009;5(1):23-30. [Medline].

  17. Gönül M, Kiliç A, Cakmak SK, Gül U, Ekiz OD, Ergül G. Juvenile generalized acanthosis nigricans without any systemic disease. Pediatr Int. Aug 2009;51(4):595-7. [Medline].

  18. Coates P, Shuttleworth D, Rees A. Resolution of nicotinic acid-induced acanthosis nigricans by substitution of an analogue (acipimox) in a patient with type V hyperlipidaemia. Br J Dermatol. Apr 1992;126(4):412-4. [Medline].

  19. Sherertz EF. Improved acanthosis nigricans with lipodystrophic diabetes during dietary fish oil supplementation. Arch Dermatol. Jul 1988;124(7):1094-6. [Medline].

  20. Adigun CG, Pandya AG. Improvement of idiopathic acanthosis nigricans with a triple combination depigmenting cream. J Eur Acad Dermatol Venereol. Apr 2009;23(4):486-7. [Medline].

  21. Mork NJ, Rajka G, Halse J. Treatment of acanthosis nigricans with etretinate (Tigason) in a patient with Lawrence-Seip syndrome (generalized lipodystrophy). Acta Derm Venereol. 1986;66(2):173-4. [Medline].

  22. Darmstadt GL, Yokel BK, Horn TD. Treatment of acanthosis nigricans with tretinoin. Arch Dermatol. Aug 1991;127(8):1139-40. [Medline].

  23. Walling HW, Messingham M, Myers LM, Mason CL, Strauss JS. Improvement of acanthosis nigricans on isotretinoin and metformin. J Drugs Dermatol. Dec 2003;2(6):677-81. [Medline].

  24. Sherertz EF. Improved acanthosis nigricans with lipodystrophic diabetes during dietary fish oil supplementation. Arch Dermatol. Jul 1988;124(7):1094-6. [Medline].

  25. Romo A, Benavides S. Treatment options in insulin resistance obesity-related acanthosis nigricans. Ann Pharmacother. Jul 2008;42(7):1090-4. [Medline].

  26. Rosenbach A, Ram R. Treatment of Acanthosis nigricans of the axillae using a long-pulsed (5-msec) alexandrite laser. Dermatol Surg. Aug 2004;30(8):1158-60. [Medline].

  27. Ghosh S, Roychowdhury B, Mukhopadhyay S, Chowdhury S. Clearance of acanthosis nigricans associated with insulinoma following surgical resection. QJM. Nov 2008;101(11):899-900. [Medline].

  28. Hud JA Jr, Cohen JB, Wagner JM, Cruz PD Jr. Prevalence and significance of acanthosis nigricans in an adult obese population. Arch Dermatol. Jul 1992;128(7):941-4. [Medline].

  29. Torley D, Bellus GA, Munro CS. Genes, growth factors and acanthosis nigricans. Br J Dermatol. Dec 2002;147(6):1096-101. [Medline].

 
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Brown velvety plaques with skin tags in the axilla of a patient with acanthosis nigricans.
Acanthosis nigricans.
Acanthosis nigricans, obesity related.
Acanthosis nigricans of the axilla with one skin tag.
Acanthosis nigricans biopsy. The epidermis is papillomatous (undulates) and pigmented ("nigricans"). Acanthosis (thickening of the spinous layer) is often not really present, so acanthosis nigricans is often a misnomer in many cases.
Table. Acanthosis Nigricans Associations
Syndromes Associated With Acanthosis NigricansMalignant Diseases Associated With Acanthosis Nigricans
AcromegalyBile duct cancer
Alstrom telangiectasiaBladder cancer
Barter syndromeBreast cancer
Beare-Stevenson syndromeColon cancer
Benign encephalopathyEndometrial cancer
Bloom syndromeEsophageal cancer
Capozucca syndromeGallbladder cancer
Chondrodystrophy with dwarfismHodgkin disease
Costello syndromeKidney cancer
Crouzon syndromeLiver cancer
DermatomyositisLung cancer
Familial pineal body hypertrophyMycosis fungoides
GigantismNon-Hodgkin lymphoma
Hashimoto thyroiditisOvarian cancer
Hirschowitz syndromePancreatic cancer
Lawrence-Moon-Bardet syndromePheochromocytoma
Lawrence-Seip syndromeProstate cancer
Lipoatrophic diabetes mellitusRectal cancer
Lupoid hepatitisTesticular cancer
Lupus erythematosusThyroid cancer
PhenylketonuriaWilms tumor
Pituitary hypogonadism
Pseudoacromegaly
Prader-Willi syndrome
Pyramidal tract degeneration
Rud syndrome
Scleroderma
Stein-Leventhal syndrome
Type A syndrome (HAIR-AN syndrome)
Werner syndrome
Wilson syndrome
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