Acanthosis Nigricans: How to Manage

 

Treatment of acanthosis nigricans involves topical treatment and removal of the offending cause of the skin thickening and pigmentation.

Treatment of Acanthosis Nigricans: Treating the Cause
Treatment of Acanthosis nigricans involves treating the Cause

Tips on Dealing with Acanthosis Nigricans

There are certain do’s and don’ts in dealing with acanthosis nigricans. These are important in limiting the spread of the disease and finding the underlying causes.

Do’s in dealing with acanthosis nigricans:

  • The first course open to a patient is of course differentiating the benign and malignant varieties of acanthosis nigricans, preferably with the help of a dermatologist.
  • Diet control and regular exercise to reduce weight is essential in controlling acanthosis nigricans
  • Diabetes, if present, should be brought under strict control through dietary restriction, exercises and effective medications
  • In case of suspected malignant acanthosis nigricans, full panel of laboratory investigations should be carried out without much delay. Tumor markers, hormonal assays, endoscopy, Ultrasound and CT scans and whole body MRI are mandatory in such cases. The appearance of acanthosis nigricans can precede the full expression of cancer even by 5 years.
  • Consultations with a general physician and a gastro-enterologist once in six months is advisable in suspected acanthosis nigricans where no primary focus could be found in previous check ups. The frequency should be increased in cases where the skin changes are rapidly progressing.
  • Any sudden progression of the skin condition, appearance of skin tags or seborrheic keratosis (Leser Trelat sign) calls for urgent medical consultation.

 

Acanthosis nigricans treatments depends upon finding and treating the basic cause

Don’ts in Dealing with Acanthosis Nigricans

There are certain things to be avoided in the presence of acanthosis nigricans:

Most people think that the dirty appearance of the skin in acanthosis nigricans is due to dirt deposition on the skin. This results in constant vigorous scrubbing of the involved skin. This should be avoided at all cost.

So, Don’t

  • Scrub too much, as frequent rubbing will only increase skin thickening and pigmentation
  • Use strong abrasives: tend to irritate the skin more.

Treatment Guidelines for  Acanthosis Nigricans

  1. Correction of underlying cause
  • Removal of tumor
  • Correction of endocrine disorder: In case of Insulin Resistance, Metformin could be useful in treating Acanthosis Nigricans, alone or in combination with Rosiglitazone.
  • Reduction of weight: Low carb diets and exercise will help.
  • Removal of causative drug
  • Dietary supplimentation with fish oil containing omega 3 fatty acids have been reported to be beneficial
  • Cyproheptadine has been found useful in some cases

 2. Management of Skin Lesions:

  • Topical Retin A
  • Salicylic acid application alone or in combination with steroids, alternating with emollient applications to minimize irritation.
  • Calcipotriol
  • In severe unresponsive cases, systemic retinoids are useful.
  • TCA Peels, laser ablation all have been tried with varying results

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Published by Dr Hanish Babu, MD on 29th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

 

Acanthosis Nigricans: How to Differentiate Malignant from Benign

 

We have already seen the main causes and different types of Acanthosis Nigricans.

As acanthosis nigricans is, at times, a fore-runner of internal cancer, it is important to differentiate between the harmless benign acanthosis nigricans from the malignant variety of acanthosis nigricans, as early diagnosis of cancer could be life saving. It is reported that the appearance of acanthosis nigricans precedes the appearance of internal cancer even before a couple of years!

Malignant Acanthosis Nigricans has to be Differentiated from Benign

Even after treatment of the causative cancer, acanthosis nigricans plays an important role as a followup indicator as well. Usually when the cancer is surgically excised and treated with radiation or chemotherapy, acanthosis nigricans disappears. Any recurrence of acanthosis nigricans later may thus point to recurrence of the cancer.

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!

How to Differentiate Benign from Malignant Acanthosis Nigricans?

If any of the following features are present in a patient with acanthosis nigricans, presence of internal cancer may be suspected:

  1. Age of onset: Benign acanthosis nigricans appear soon after birth, childhood or in puberty. Early age of onset should arouse suspicion.
  2. Speed of Progression: If the typical features of acanthosis nigricans appear and progress rapidly, it is indicative of a malignant origin.
  3. Severity of Skin Changes: In malignant acanthosis nigricans, the skin changes are more pronounced compared to the benign types of acanthosis nigricans. The dark color (pigmentation) is present beyond the area of thickening in the malignant acanthosis nigricans.
  4. Distribution of Skin Lesions: In malignant acanthosis nigricans, there is extensive involvement of the skin, almost all folds and palms and soles and face are involved.
  5. Mucous membrane involvement: In contrast to the benign acanthosis nigricans, mucous membrane involvement is prominent in about 50% of malignant type of acanthosis nigricans.
  6. Skin Tags: Sudden appearance of skin tags in a case of acanthosis nigricans is indicative of serious underlying illness.
  7. Symptoms: Most benign acanthosis nigricans are asymptomatic. Usually there is irritation and itching in the skin lesions of malignant acanthosis. 

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Published by Dr Hanish Babu, MD on 29th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

Acanthosis Nigricans, a Marker of Cancer: Types, Causes and Diagnosis

 

Acanthosis Nigricans
Acanthosis Nigricans can be a marker of Internal Cancer

Acanthosis nigricans is a dark and velvety thickening of the skin in the armpits, neck and other body folds. It is considered as a marker for certain internal malignancies and endocrinal disturbances.

Acanthosis nigricans may occur due to a hereditary predisposition or associated with many diseases and medications.  People with acanthosis nigricans are known for their resistance to insulin in diabetics. The importance of acanthosis nigricans lies in the fact that at times it could be associated with certain cancers. Infact, sudden appearance of  acanthosis nigricans at any age calls for a thorough investigation of body systems to rule out any underlying cancers.

What is the Cause for Acanthosis Nigricans?

As mentioned above, there are many causes for acanthosis nigricans. According to the underlying cause, acanthosis nigricans is divided into 5 different types.

  1. Hereditary Benign Acanthosis Nigricans. This type runs in families and there is usually no associated endocrine disorders. This type of acanthosis nigricans appears in childhood and increases at puberty though many regress with age.
  2. Benign Syndromic Acanthosis Nigricans. This is associated with certain endocrine diseases. Insulin resistance is an underlying pathology in benign acanthosis nigricans. Most patients will have any of the following hormonal problems: diabetes, increased androgen secreting tumors, acromegaly or gigantism, Cushing’s syndrome, Addison’s disease , hypothyroidism etc. Course depends upon the management of underlying disturbance.
  3. Pseudo Acanthosis Nigricans  associated with Obesity. Starts at puberty. Common among dark skinned. Obesity—insulin resistance. Regression seen with significant weight loss.
  4. Drug induced Acanthosis Nigricans. High dose nicotinic acid, stilbesterol in young males, systemic steroid therapy, certain OCPs, growth hormone therapy, insulin, pituitary extract, protease inhibitors are some of the medications that can cause acanthosis nigricans
  5. Malignant Acanthosis Nigricans. Associated with adenocarcinoma of GIT and GUT tracts, less commonly with lymphomas. Even as early as 5 years of onset of other signs and symptoms of certain malignancies. Usually regress after successful treatment.

The typical skin features of thickening and dark pigmentations in acanthosis nigricans are caused by  certain chemicals secreted by the tumors or the effect of hormones, including insulin on the skin fibroblasts and melanocytes.

How Can Acanthosis Nigricans be Diagnosed?

Acanthosis nigricans has to be differentiated from diseases like Confluent and Reticulated papillomatosis, pigmented pityriasis versicolor, X-linked Icthyosis, retention hyperkeratosis and excessive nicotinic acid ingestion. Diagnosis of acanthosis nigricans is mainly from the history and clinical presentations. A complete workout including a hormonal profile, blood sugar,  biopsy of the skin and histopathological study, and, in case of suspected malignant acanthosis nigricans, a full body imaging and endoscopy is called for.

Clinical Features

Irrespective of the cause, all varieties of acanthosis nigricans show a  dark pigmentation and thickening of the skin, usually in a symmetrical manner, on the neck, axillae, groins, elbows, behind the knees, around umbilicus and in the perianal region. Skin looks dirty and the surface is wavy and rugose with a velvety appearance. Skin lines show up prominently. In acanthosis associated with obesity, the dark, thickened and velvety patches are more pronounced on the apposed surfaces of the folds, especially the thighs. Skin tags appear in large numbers in these patients.

In the severe malignant variety, all features of acanthosis nigricans are accentuated: the skin is  more thickened, dark and velvety and there is often involvement of the palms, soles, oral cavity and the edges of the lips.

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Published by Dr Hanish Babu, MD on 29th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD