Acanthosis Nigricans

Confirm the clinical phenotype: symmetric, hyperpigmented, velvety plaques with poorly defined borders, usually in intertriginous areas, support acanthosis nigricans. Skin tags commonly coexist around affected sites in insulin-resistant phenotypes. PubMed+1PubMedAcanthosis Nigricans: An Updated Review - PubMedPubMedA STUDY OF PATHOGENESIS OF ACANTHOSIS NIGRICANS AND ITS CLINICAL IMPLICATIONS

The common branch is obesity-associated insulin resistance. In children, adolescents, and adults with overweight or central adiposity, neck and axillary involvement should redirect the encounter toward dysglycemia, dyslipidemia, hypertension, and fatty-liver risk rather than biopsy or lesion-directed therapy. Acanthosis nigricans identifies higher metabolic risk, but obesity is more predictive of insulin resistance than the skin finding alone. BMJ+2BMJType 2 diabetes in children - Symptoms, diagnosis and treatment | BMJ Best Practice USPubMedAn approach to acanthosis nigricans - PMCPubMedAcanthosis Nigricans – A Two-Sided Coin: Consider Metabolic Syndrome and Malignancies! - PMC

Escalate beyond routine metabolic assessment when lesions are abrupt, rapidly progressive, extensive or generalized, involve oral or other mucosa, or arise in a nonobese patient without an evident insulin-resistant state. Malignant lesions can be clinically indistinguishable from benign lesions; gastrointestinal adenocarcinoma, particularly gastric carcinoma, is the classic association. ScienceDirect+2ScienceDirectAcanthosis Nigricans - an overview | ScienceDirect TopicsPubMedAcanthosis Nigricans: An Updated Review - PubMedPubMedA STUDY OF PATHOGENESIS OF ACANTHOSIS NIGRICANS AND ITS CLINICAL IMPLICATIONS

At the initial visit, record height, weight, BMI, waist or hip circumference when useful for adiposity assessment, and blood pressure. Examine for skin tags, hirsutism, goiter, abdominal tenderness or hepatomegaly, and broad pink striae when the history suggests endocrine disease. WHO+1WHO[PDF] PHC ENG GUIDE 200 - Extranet SystemsPubMedAcanthosis Nigricans – A Two-Sided Coin: Consider Metabolic Syndrome and Malignancies! - PMC

Obtain fasting plasma glucose and hemoglobin A1c to detect dysglycemia, and obtain a fasting lipid profile to identify atherogenic dyslipidemia. Add ALT when obesity-associated metabolic dysfunction or hepatic steatosis is a concern; overweight and obese children with acanthosis nigricans have demonstrated higher fasting glycemia, insulin, HOMA index, triglyceride-related metabolic abnormalities, and aminotransferase levels than peers without lesions. WHO+1WHO[PDF] PHC ENG GUIDE 200 - Extranet SystemsPubMedAcanthosis Nigricans – A Two-Sided Coin: Consider Metabolic Syndrome and Malignancies! - PMC

Do not use acanthosis nigricans as a stand-alone proxy for insulin resistance or type 2 diabetes. In obese children, the presence of lesions is associated with insulin resistance, but obesity itself remains the more important determinant; a normal glucose result does not negate the need to address excess adiposity and longitudinal metabolic risk. PubMed+1PubMedAcanthosis nigricans is a reliable cutaneous marker of insulin resistance in obese Japanese children - PubMedPubMedAn approach to acanthosis nigricans - PMC

Consider endocrine-associated acanthosis nigricans when there are syndrome-specific findings. Hyperandrogenic and hypogonadal states, Cushing disease, Addison disease, hypothyroidism, and diabetes-related insulin resistance have been reported associations. In a patient with corresponding symptoms or examination findings, test for the suspected disorder rather than applying a broad endocrine panel. ScienceDirect+1ScienceDirectAcanthosis nigricans, hypothyroidism, and insulin resistance - ScienceDirectScienceDirectAcanthosis Nigricans - an overview | ScienceDirect Topics

Type B insulin resistance is an autoimmune syndrome caused by insulin-receptor autoantibodies and can produce severe insulin resistance with hyperglycemia or, less often, hypoglycemia. During a spontaneous hypoglycemic event, obtain glucose with insulin, proinsulin, and C-peptide; confirmation requires insulin-receptor autoantibody detection. The coexistence of acanthosis nigricans, extreme hyperinsulinemic biochemistry, autoimmune features, and hyperandrogenism or female virilization should prompt urgent endocrinology involvement. Wiley+1WileyA case of type B insulin resistance presenting at a district general ...Wolters KluwerAutoimmune Forms of Hypoglycemia : Medicine

For suspected malignant acanthosis nigricans, use history and examination to direct cancer testing rather than assuming that lesion morphology distinguishes malignant from metabolic disease. Gastric carcinoma is the most common reported tumor association, and adenocarcinomas of the gastrointestinal tract, ovary, lung, and breast have been described. Mucosal involvement may include the oral cavity, nasal or laryngeal mucosa, or esophagus. ScienceDirect+1ScienceDirectAcanthosis Nigricans - an overview | ScienceDirect TopicsPubMedA STUDY OF PATHOGENESIS OF ACANTHOSIS NIGRICANS AND ITS CLINICAL IMPLICATIONS

For obesity-associated acanthosis nigricans, make weight reduction and treatment of insulin resistance the primary intervention. Weight loss can improve obesity-related disease, and control of hyperinsulinemia through dietary change may reduce lesion severity. Treat documented diabetes, dyslipidemia, hypertension, polycystic ovary syndrome, or suspected fatty-liver disease according to the relevant disease pathway. ScienceDirect+2ScienceDirectSuccessful treatment of acanthosis nigricans with etretinate - ScienceDirectScienceDirectAcanthosis Nigricans - an overview | ScienceDirect TopicsPubMedAcanthosis Nigricans: An Updated Review - PubMed

When an identifiable medication is implicated, discontinue or substitute it when clinically feasible. If a defined endocrinopathy or internal malignancy is driving the lesions, direct treatment to that disorder; this approach may improve acanthosis nigricans and avoids ineffective escalation of cosmetic therapies. PubMedPubMedAcanthosis Nigricans: An Updated Review - PubMed

Use lesion-directed therapy only after addressing the driver and clarifying that evidence is largely symptomatic or cosmetic. Localized lesions may be treated with topical retinoids, vitamin D analogs, chemical peels, or other keratolytics; systemic oral retinoids have been considered for extensive, generalized, or topical-treatment–unresponsive disease. Laser therapy, dermabrasion, and surgical removal are less common options. PubMedPubMedAcanthosis Nigricans: An Updated Review - PubMed

Clinical diagnosis is usually sufficient when the morphology and metabolic context are typical. Consider dermatology evaluation and biopsy when morphology is atypical, distribution is unusual, facial pigmentation raises competing diagnoses, or a mimicker such as an acanthosis nigricans-like variant of mycosis fungoides is plausible. Patch-stage mycosis fungoides may require multiple skin biopsies. Oxford Academic+1Oxford AcademicMycosis fungoides: a review - Oxford AcademicWolters KluwerFacial acanthosis nigricans − a narrative review : Pigment International

Refer urgently to endocrinology for suspected type B insulin resistance or severe dysglycemia with disproportionate hyperinsulinemia, and coordinate expedited malignancy evaluation for rapid, generalized, mucosal, or nonobese disease. The referral question should specify the phenotype, lesion tempo, glucose pattern, insulin/C-peptide results when obtained, medication exposures, and systemic cancer symptoms. Wiley+3WileyA case of type B insulin resistance presenting at a district general ...Wolters KluwerAutoimmune Forms of Hypoglycemia : MedicineScienceDirectAcanthosis Nigricans - an overview | ScienceDirect TopicsPubMedAcanthosis Nigricans: An Updated Review - PubMed