Medical Care
No treatment of choice exists for acanthosis nigricans (AN). [24] 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.
Cessation of the 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. [25] Dietary fish oil reportedly is beneficial in patients with lipodystrophic diabetes and generalized acanthosis nigricans, even if niacin is continued. [26]
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. [27] Calcipotriol, podophyllin, urea, adapalene, and salicylic acid also have been reported, with variable results. [1, 28, 29]
Oral agents that have shown some benefit include etretinate, [30] isotretinoin, [31, 32] metformin, [33] and dietary fish oils. [34] Octreotide showed sustained improvement in one patient with insulin resistance 6 months after completing the course. [35]
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 occasional long-term remissions. [36]
Surgical removal of tumors is the mainstay of treatment for malignant acanthosis nigricans, if possible, because clearance following primary malignancy excision has been reported. [37]
Cyproheptadine has been used in cases of malignant acanthosis nigricans because it may inhibit the release of tumor products. [38]
Psoralen plus UVA (PUVA) has been reported as beneficial for symptomatic relief in cases of paraneoplastic acanthosis nigricans. [5]
Surgical Care
Dermabrasion and long-pulsed alexandrite laser therapy may also be used to reduce the bulk of the lesion, with occasional long-term remissions. [39]
Surgical removal of tumors is the mainstay of treatment for malignant acanthosis nigricans, if possible, because clearance following primary malignancy excision has been described. [37]
Consultations
Based on underlying etiology, multidisciplinary evaluation may include the following:
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Primary care physician (pediatrician, internist, or family practitioner)
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Endocrinologist
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Oncologist
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Geneticist
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Dermatologist
Diet
Weight loss and glycemic control are essential for those with obesity-related acanthosis nigricans or hyperinsulinemic states.
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Brown velvety plaques with skin tags in the axilla of a patient with acanthosis nigricans.
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Acanthosis nigricans.
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Acanthosis nigricans, obesity related.
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Acanthosis nigricans of the axilla with one skin tag.
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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.
Tables
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 |
|
