Acanthosis Nigricans; A Skin Marker of Internal Disease

What is Acanthosis Nigricans?Acanthosis nigricans is the cry of the skin for attention! It is a skin disorder characterized by thickening, pigmentation and a fine or rough velvety appearance, particularly over body folds like neck, axilla and groin. The importance of acanthosis nigricans lies in the fact that it can be caused by a variety of diseases, from obesity to cancer.People with acanthosis nigricans are known for their resistance to insulin in diabetes.According to the causes, acanthosis nigricans is divided into two major types: A. BENIGN ACANTHOSIS NIGRICANSHereditary benign acanthosis nigricans: This runs in families, but does not usually show any evidence of endocrinological disturbances or internal malignancy.Endocrinal acanthosis nigricans: It is associated with many endocrine problems like acromegaly, addison’s disease, Cushing’s diseases, insulin resistant diabetes mellitus, hypothyroidism, ovarian hyperthecosis, hepatic cirrhosis,Wilson’s disease etc Pseudo acanthosis nigricans: This is a reversible type and usually starts in puberty. It commonly affects dark skinned people and is associated with obesity. Drug induced acanthosis nigricans: Nicotinic acid is notorius in causing acanthosis nigricans. Other drugs like stilbostreol, corticosteroids, oral contraceptive pills etc can also cause acanthosis nigricans like lesions. B. MALIGNANT ACANTHOSIS NIGRICANS(Associated with cancerous growths within): Internal malignancies (cancers), especially the adenocarcinomas affecting the stomach, lungs etc can cause acanthosis nigricans. Sometimes lymphoma may be the culprit.Hence it is essential to find out the cause of acanthosis nigricans. Here are a few pointers that may help in differentiating benign from malignant variety of acanthosis nigricans:How to Differentiate Between the Innocent Benign and the Dangerous Malignant Varieties? Onset : Benign – Birth, childhood or puberty. Malignant – Adulthood, old ageDistribution: Extent of involvement: Benign – Less. Malignant – WidespreadDistal extremities:: Benign – Spared. Malignant – Affected Mucous membrane involvement: Benign – Rare. Malignant – Common-up to 50%Hair, nail, palms & soles: Benign – Rare, Malignant – CommonPigmentation: Benign – Less, limited to thickened areas. Malignant – More, extend beyond thickened areas.Skin Thickening: Benign – Mild to moderate. Malignant – MarkedSkin Irritation: Benign – Less or nil. Malignant – MoreWhen to Consult Dermatologist? When the pigmentation is severe and the signs of malignancy is present as above.Salient Points indicating presence of associated internal cancer are: Late onset Rapid progression Severe affection Extensive distribution Mucous membrane involvement More symptoms like irritation and sudden appearance of skin tags Tips On Dealing With Acanthosis Nigricans Do’s: Differentiate between benign and malignant with the help of a dermatologistReduction of weightStrict diabetic controlRegular aerobic exercisesFull investigations including tumor markers, hormonal assay, ultra sound scan, MRI etcRegular medical check up, semi annualReport any sudden changes in morphologyDon’ts: Scrub too much, as frequent rubbing will only increase skin thickening and pigmentation.Use strong abrasives: tend to irritate the skin more.Treatment Guidelines of Acanthosis Nigricans 1. Correction of underlying cause Removal of tumor Correction of endocrine disorder Reduction of weight Removal of causative drug 2. Dietary supplementation with fish oil containing omega 3 fattyacids have been reported to be beneficial 3. Cyproheptadine has been found useful in some cases4. Management of Skin Lesions: Topical Retin A Salicylic acid application alone or in combination with steroids, alternating with emollient applications to minimize irritation. In severe unresponsive cases, systemic retinoids may be given a trial. An Interesting Case Curth HO (Archives of Dermatology, Vol 102, 1970) reports a remarkable case of acanthosis nigricans persisting for years even after excising a leiomyoma of stomach,squamous cell carcinoma of bladder and nephrectomy of one kidney for transitional cell carcinoma in a 84 year old man. Then one lesion of adenocarcinoma was found in his colon and removed. Surprise! His long standing acanthosis nigricans disappeared within a few days without any treatment! Moral: To achieve cure you must excise the responsible hormone secreting tumor, not just any tumor!Disclaimer: Information provided in this article is strictly for educational purposes and is not meant to substitute for the advice provided by your own dermatologist or other medical professionals. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. Many skin diseases have similar morphology and may resemble one another, though their treatment protocol varies. Hence, self diagnosis and treatment are not advised. In case of doubt always be on the safer side and consult your dermatologist or physician.

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