Medication Summary

The goal of pharmacotherapy in acanthosis nigricans is to improve cosmetic appearance.

Class Summary

These agents promote shedding of hyperkeratotic skin. They are modifiers of keratinocyte adhesion, differentiation, and proliferation.

Tretinoin topical (Avita, Retin-A)

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Topical tretinoin promotes detachment of cornified cells and enhances shedding of corneocytes. It inhibits microcomedo formation and eliminates lesions that are present. Tretinoin makes keratinocytes in sebaceous follicles less adherent and easier to remove. It is available as 0.025%, 0.05%, and 0.1% creams and as 0.01% and 0.025% gels.

Ammonium lactate

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Ammonium lactate is an alpha-hydroxy acid; it is a normal constituent of tissues and blood. Ammonium lactate is believed to act as a humectant when applied to the skin. This may influence hydration of the stratum corneum. In addition, when applied to the skin, it may act to decrease corneocyte cohesion. The mechanism(s) by which this is accomplished is not yet known.

Questions

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Media Gallery

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.

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Table. Acanthosis Nigricans Associations

Table. Acanthosis Nigricans Associations

Syndromes Associated With Acanthosis Nigricans	Malignant Diseases Associated With Acanthosis Nigricans
Acromegaly	Bile duct cancer
Alstrom telangiectasia	Bladder cancer
Barter syndrome	Breast cancer
Beare-Stevenson syndrome	Colon cancer
Benign encephalopathy	Endometrial cancer
Bloom syndrome	Esophageal cancer
Capozucca syndrome	Gallbladder cancer
Chondrodystrophy with dwarfism	Hodgkin disease
Costello syndrome	Kidney cancer
Crouzon syndrome^[10]	Liver cancer
Dermatomyositis	Lung cancer
Familial pineal body hypertrophy	Mycosis fungoides^[11]
Gigantism	Non-Hodgkin lymphoma
Hashimoto thyroiditis	Ovarian cancer
Hirschowitz syndrome	Pancreatic cancer
Lawrence-Moon-Bardet syndrome	Pheochromocytoma
Lawrence-Seip syndrome	Prostate cancer
Lipoatrophic diabetes mellitus	Rectal cancer
Lupoid hepatitis	Testicular cancer
Lupus erythematosus	Thyroid cancer
Phenylketonuria	Wilms 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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Author

Jason H Miller, MD Clinical Assistant Professor of Dermatology, Rutgers Robert Wood Johnson Medical School; Private Practice, Hametz and Picascia Dermatology Associates

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, Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Frank Winsett, MD University of Texas Health Science Center at Houston

Disclosure: Nothing to disclose.

Ronald P Rapini, MD Professor and Chair, Department of Dermatology, The University of Texas MD Anderson Cancer Center; Distinguished Chernosky Professor and Chair of Dermatology, Professor of Pathology, University of Texas McGovern Medical School at Houston

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, American Society of Dermatopathology, Association of Professors of Dermatology, Society for Investigative Dermatology, Texas Dermatological Society

Disclosure: Book royalties from Elsevier publishers.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, 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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Ponciano D Cruz, Jr, MD Professor and Vice-Chair, Paul R Bergstresser Chair, 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: Received consulting fee from RCTS for independent contractor; Received honoraria from Mary Kay Cosmetics for consulting; Received grant/research funds from Galderma for principal investigator.

Acknowledgements

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