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Current Pediatric Reviews 2022Early recognition of acanthosis nigricans is important because acanthosis nigricans can be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a... (Review)
Review
BACKGROUND
Early recognition of acanthosis nigricans is important because acanthosis nigricans can be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy.
OBJECTIVE
The purpose of this article is to familiarize pediatricians with the clinical manifestations, evaluation, diagnosis, and management of acanthosis nigricans.
METHODS
A search was conducted in November 2021in PubMed Clinical Queries using the key term "acanthosis nigricans". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.
RESULTS
Acanthosis nigricans is characterized by symmetric, hyperpigmented, and velvety plaques with ill-defined borders, typically involving intertriginous areas. Obesity is the most common cause of acanthosis nigricans which is increasingly observed in obese children and adolescents and can serve as a cutaneous marker of insulin resistance. Early recognition of acanthosis nigricans is important because acanthosis nigricans can also be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. This may consist of weight reduction, discontinuation of causative drugs, treatment of underlying endocrinopathy, or treatment of an underlying malignancy. For patients with isolated acanthosis nigricans and for those whose underlying cause is not amenable to treatment, treatment of the lesion may be considered for cosmetic reasons. Topical retinoids, vitamin D analogs, chemical peels, and other keratolytics are often used for the treatment of localized lesions. Seldom, systemic therapy such as oral retinoids may be considered for extensive or generalized acanthosis nigricans and acanthosis nigricans unresponsive to topical therapy. Other uncommon treatment modalities include dermabrasion, laser therapy, and surgical removal.
CONCLUSION
Although acanthosis nigricans is treatable, a complete cure is difficult to achieve. The underlying cause should be treated, if possible, to resolve and prevent the recurrence of acanthosis nigricans. The diagnosis is mainly clinical, based on the characteristic appearance (symmetrically distributed, hyperpigmented, velvety, papillomatous, hyperkeratotic plaques with ill-defined borders) and the typical sites (intertriginous areas, flexural area, and skin folds) of the lesions. The diagnosis might be difficult for lesions that have atypical morphology or are in an unusual location. Clinicians should be familiar with the clinical signs, evaluation, diagnosis, and therapy of acanthosis nigricans because of the link between it and underlying diseases.
Topics: Adolescent; Humans; Child; Acanthosis Nigricans; Pediatric Obesity; Neoplasms; Insulin Resistance; Retinoids
PubMed: 36698243
DOI: 10.2174/1573396318666220429085231 -
Journal of Cosmetic Dermatology Aug 2020Acanthosis nigricans (AN) is a cutaneous disorder characterized by symmetric velvety hyperpigmented plaques on intertriginous areas like axilla, neck, inframammary, and... (Review)
Review
BACKGROUND
Acanthosis nigricans (AN) is a cutaneous disorder characterized by symmetric velvety hyperpigmented plaques on intertriginous areas like axilla, neck, inframammary, and groin.
AIMS
To summarize the pathophysiology and classification of AN, provide an update of diagnostic testing strategies, and describe the current therapeutic options described so far in the literature for this disease.
METHODS
A comprehensive english language literature search across multiple databases (PubMed, EMBASE, MEDLINE, and Cochrane) for keywords (alone and in combination) was performed. MeSH as well as non-MeSH terms such as "acanthosis nigricans," "classification," "pathophysiology," "diagnosis," "treatment," "topical drugs," "systemic drugs," "chemical peeling," and "lasers" were taken into consideration.
RESULTS
The pathophysiology of AN revolves around a multifactorial stimulation of proliferation of epidermal keratinocytes and dermal fibroblasts. Various types of AN include benign, obesity-associated, syndromic, malignant, acral, unilateral, medication-induced, and mixed-type. Homeostasis model assessment-insulin resistance (HOMA-IR) is a good tool for assessment of insulin resistance. Management involves general measures (weight reduction and addressing the underlying cause, if any), topical drugs (retinoids, vitamin D analogs, and keratolytics), oral drugs (retinoids and insulin sensitizers), chemical peels (trichloroacetic acid), and lasers (Long pulsed alexandrite, fractional 1550-nm erbium fiber, and CO ).
CONCLUSION
Acanthosis nigricans is a treatable condition; however, complete cure and disappearance of lesions are difficult to achieve. Weight reduction is the most scientific and practical management strategy. Long-term studies and further research is warranted in the pathophysiology and treatment of this common condition.
Topics: Acanthosis Nigricans; Humans; Insulin Resistance; Obesity; Retinoids; Vitamin D
PubMed: 32516476
DOI: 10.1111/jocd.13544 -
Pediatric Dermatology Mar 2022
Topics: Acanthosis Nigricans; Humans
PubMed: 35434860
DOI: 10.1111/pde.14973 -
Journal of Basic and Clinical... 1998Acanthosis nigricans is a lesion affecting localized areas of the skin in persons with obesity and/or hyperinsulinemia. Roughening of the skin correlates with... (Review)
Review
Acanthosis nigricans is a lesion affecting localized areas of the skin in persons with obesity and/or hyperinsulinemia. Roughening of the skin correlates with histological papilomatosis and the apparent darkening is due to hyperkeratosis. Biochemical mechanisms for developing this hyperplastic lesion are unclear, but likely involve local cutaneous growth factors. Cross sectional surveys of unselected populations have demonstrated that young children have low prevalences of obesity and acanthosis nigricans, but the prevalences of both increase with increasing age until plateaus are reached after the age of ten. Nearly 40% of Native American teenagers have acanthosis nigricans, whereas about 13% of African American, 6% of Hispanic, and less than 1% of white, non-Hispanic children aged 10-19 have clinically apparent acanthosis nigricans. We conclude that the presence of this skin lesion is a clinical surrogate of laboratory-documented hyperinsulinemia. Acanthosis nigricans identifies a subgroup within an ethnic group who have the highest insulin concentration, the most severe insulin resistance, and thus the highest risk for the development of type 2 diabetes.
Topics: Acanthosis Nigricans; Adolescent; Adult; Animals; Child; Child, Preschool; Ethnicity; Female; Humans; Hyperinsulinism; Insulin; Male; Mice; Obesity
PubMed: 10212845
DOI: 10.1515/JBCPP.1998.9.2-4.407 -
Oral Surgery, Oral Medicine, and Oral... Apr 1987Acanthosis nigricans (AN) is a well-defined skin disorder characterized by velvety hyperkeratotic macules that can be accompanied by various degrees of pigmentation.... (Review)
Review
Acanthosis nigricans (AN) is a well-defined skin disorder characterized by velvety hyperkeratotic macules that can be accompanied by various degrees of pigmentation. Other manifestations of AN are marked papillomatous growths and deep skin markings. These changes can affect the entire skin but preferentially are observed in the axilla, neck, genitals, and oral cavity. The presence of AN around and within the oral cavity as well as its well-known association with internal malignant conditions, especially adenocarcinoma of the stomach, and/or its association with insulin resistance, has prompted this review article, which emphasizes the oral manifestations of AN.
Topics: Acanthosis Nigricans; Humans; Mouth Diseases
PubMed: 3554094
DOI: 10.1016/0030-4220(87)90259-3 -
Clinics in Dermatology 2018
Review
Topics: Acanthosis Nigricans; Age Factors; Asian People; Body Mass Index; Comorbidity; Female; Humans; Male; Metabolic Syndrome; Prevalence; Prognosis; Risk Assessment; Severity of Illness Index; Sex Factors
PubMed: 29241752
DOI: 10.1016/j.clindermatol.2017.09.008 -
Dermatologic Therapy Mar 2021Drug-induced acanthosis nigricans is an uncommon subtype of acanthosis nigricans and the data on this topic is not well understood by clinicians as it is presently... (Review)
Review
Drug-induced acanthosis nigricans is an uncommon subtype of acanthosis nigricans and the data on this topic is not well understood by clinicians as it is presently limited in the literature. Previous reports of drug-induced acanthosis nigricans have simply consisted of a list of drugs possibly implicated in causing acanthosis nigricans. Several drugs listed are based on single case reports without biopsy confirmation, report of clearing on stopping the drug or reporting on whether acanthosis nigricans recurred with drug rechallenge. A comprehensive literature search was conducted using PubMed, EMBASE(Ovid), Cochrane Library, Scopus, and Web of Science electronic databases. The authors screened the initial result of the search strategy by title and abstract using the following inclusion criteria: eligible studies included those with patients who developed acanthosis nigricans secondary to a drug. This study is the first to comprehensively review the drugs that have been implicated in the development of acanthosis nigricans. A total of 38 studies were included in the systematic review, and a total of 13 acanthosis nigricans inducing drugs were identified. Nicotinic acid and insulin were the two most significant drugs that were reported to cause acanthosis nigricans. By using the results of this study, we created a revised classification system of drug-induced acanthosis nigricans which can be used as a concise framework for clinicians to refer to.
Topics: Acanthosis Nigricans; Biopsy; Drug Eruptions; Humans; Neoplasm Recurrence, Local; Pharmaceutical Preparations
PubMed: 33480113
DOI: 10.1111/dth.14794 -
Clinical and Experimental Dermatology Apr 2022Oral papillary lesions represent a variety of developmental and neoplastic conditions. Early diagnoses of different papillary lesions are challenging for oral medicine... (Review)
Review
Oral papillary lesions represent a variety of developmental and neoplastic conditions. Early diagnoses of different papillary lesions are challenging for oral medicine specialists. Malignant acanthosis nigricans (MAN) is a rare cutaneous disorder and a potential marker of underlying hidden tumours. It is characterized by papillary lesions that always involve the oral mucosa. In oral medicine specialities, MAN is not well understood. When the early signs of MAN are extensive oral lesions and slight cutaneous pigmentation without obvious florid cutaneous papillomatosis, the diagnosis can be incorrect or delayed. Oral medicine specialists should ask affected patients to provide details of their medical history and conduct a timely systemic examination.
Topics: Acanthosis Nigricans; Humans; Hyperplasia; Mouth Mucosa; Skin; Skin Neoplasms
PubMed: 34750849
DOI: 10.1111/ced.14995 -
Journal of the American Academy of... Sep 2007Acanthosis nigricans is a velvety thickening of the epidermis that primarily affects the axillae, posterior neck fold, flexor skin surfaces, and umbilicus, and... (Review)
Review
Acanthosis nigricans is a velvety thickening of the epidermis that primarily affects the axillae, posterior neck fold, flexor skin surfaces, and umbilicus, and infrequently is diffuse with involvement of the mucosal surfaces. It is increasingly seen in children and adolescents who are obese, and can serve as a cutaneous marker of insulin resistance and malignancy. Although malignancy-associated acanthosis nigricans is rare in the pediatric population, one need be concerned about its association with certain pediatric syndromes. More importantly, insulin resistance itself can also represent a threat to life. We review this important disorder.
Topics: Acanthosis Nigricans; Adolescent; Child; Diagnosis, Differential; Humans; Incidence; Obesity; Prevalence; Syndrome
PubMed: 17592743
DOI: 10.1016/j.jaad.2006.08.016 -
Clinics in Dermatology 1993
Review
Topics: Abdominal Neoplasms; Acanthosis Nigricans; Adenocarcinoma; Endocrine System Diseases; Humans; Paraneoplastic Syndromes
PubMed: 8339195
DOI: 10.1016/0738-081x(93)90076-o