Acanthosis nigricans: Causes, Symptoms, Treatment and Cost

Acanthosis nigricans (AN) is a skin disorder that is characterised by darkened, velvety patches of skin most commonly found in the armpits, groyne, neck and around other body folds.

There are two basic categories of acanthosis nigricans:-

• Primary acanthosis nigricans: It affects those without any underlying systemic cause. It is believed to be caused by genetic factors that are linked to certain hormones, as well as diet and lifestyle choices. This form of acanthosis nigricans tends to affect people of any age or gender but it is more common in children, especially those who have a family history of this disorder or are overweight or obese.
• Secondary acanthosis nigricans: It occurs due to an underlying medical condition or hormonal abnormality that triggers changes in the skin pigment cells (melanocytes). This type of acanthosis nigricans is typically seen in individuals with insulin resistance syndrome such as diabetes mellitus type 2, Cushing’s syndrome, thyroid disease, etc. Secondary acanthosis nigricans tend to be more severe than primary types and may not necessarily affect only folds and creases – it can spread across the entire body including trunk, thighs, shoulders etc.

Acanthosis nigricans is caused by underlying medical conditions, including:-

• Genetic Disorders,
• Endocrine Imbalances,
• Insulin Resistance, and
• Use Of Certain Medications.
• It could also arise from being overweight or obese. The reason may not always be known.

• Dark, thick, velvety, or leathery patches of skin usually on the neck, armpits, groyne area or skin folds.
• Itching feeling in the affected areas.
• Thickening of the skin.
• Patches are brownish-black color with some redness at times.
• Areas can be asymmetric including warts and/or bumps in affected areas as well as scaling or pale patches of skin adjacent to the darker patches.

• Maintaining a healthy weight involves eating a balanced diet, working out often, and limiting drastic weight changes.
• Manage existing conditions: Manage underlying medical conditions, such as diabetes and hormonal disorders, to avoid exacerbating existing symptoms.
• Reduce the use of certain lotions and cosmetics, which could worsen the condition in some cases.
• Diet: Consider dietary modifications such as limiting intake of sugary foods or those with high sodium content.
• Skin hygiene: Practise good skin hygiene by washing regularly with mild soap and avoiding lotions containing irritants or exfoliants that may lead to skin irritation or injury.

• Physical Examination: One of the primary methods to diagnose Acanthosis Nigricans is by examining physical features like appearance of lesions and lesions on neck, armpit, groyne area or knuckles. The examining doctor might perform a biopsy to confirm the diagnosis of Acanthosis Nigricans.
• Biopsy: During a biopsy, body tissue samples are tested under microscope to identify the presence of cancerous cells or any other signs of underlying health conditions such as cancer, metabolic disorder or insulin resistance etc. In case of Acanthosis Nigricans, biopsy helps to identify if there are metabolic disorders causing lesions formation like diabetes or insulin resistance etc.
• CT Scan: A CT scan is a kind of medical imaging examination that produces precise pictures of the interior of the body using X-rays and a computer. It can help diagnose Acanthosis nigricans. The scan can show signs of abnormal changes in those areas and help diagnose the underlying cause.
• Glucose Tolerance Test (GTT): A Glucose Tolerance Test (GTT) measures how well your body utilises glucose after 2-3 hours following sweetened liquid intake which helps determine if there is abnormal glucose metabolism which might indicate diabetes mellitus responsible for causing ACN developments.
• Complete Blood Count ( CBC ): CBC includes measuring red blood cell count , white blood cell count level along with haemoglobin level to monitor symptoms related to ACN formations caused due some infections.

• Risk of type 2 diabetes: Acanthosis nigricans can increase the risk of type 2 diabetes due to its relationship with metabolic syndrome and insulin resistance.
• Skin infections: People with acanthosis nigricans may be more susceptible to skin infections, such as dermatitis, due to the dryness and dark colour of the patches.
• Cancer: There is some evidence that acanthosis nigricans may be associated with an increased risk of several types of cancer, including stomach, colon, liver, ovarian, breast and prostate cancers.
• Emotional distress: The patches associated with acanthosis nigricans can lead to emotional distress due to their noticeable appearance and possible associations with obesity or underlying health conditions.

• Include neem leaves, turmeric, and sesame oil in your diet as they are known to improve skin health.
• Aloe Vera gel applied to the afflicted region might help lessen skin discoloration and dark areas.
• Consume natural antioxidants like yoghurt, garlic, ginger and amla on a daily basis to reduce inflammation.
• Apply fresh lemon juice and cucumber juice to the affected areas regularly to reduce the symptoms of Acanthosis nigricans.
• Include fenugreek powder as part of your diet; it helps to prevent the further development of Acanthosis nigricans due to its anti-inflammatory properties.

• Eating a diet rich in fruits, vegetables, whole grains, and lean meats that is well-balanced and nutritional.
• Consuming more foods rich in fibre, such oats, beans, nuts, and seeds.
• Keeping hydrated throughout the day by consuming enough water, which also helps with digestion and the absorption of nutrients from meals.

• Limit processed foods and foods with added sugars, fats, and salts.
• Additionally, foods high in sugar and saturated fats should be avoided to help manage symptoms. These include fried fast food items such as French fries or fried chicken as well as desserts with large amounts of sugar or butter.
• Foods high in carbohydrates should also be limited but it is important to still get some complex carbohydrates into the diet from sources such as quinoa, brown rice, sweet potatoes and oats.
• Avoiding fad diets as they can lead to nutrient deficiencies or imbalances which worsen the condition.

• Diet modification: Eating a healthy diet low in saturated fats and carbohydrates can help reduce symptoms of acanthosis nigricans.
• Weight loss: Being overweight or obese is a major risk factor for acanthosis nigricans, so medical professionals often recommend trying to lose weight as part of treatment.
• Medications: Medications may be prescribed to reduce inflammation, which can help improve skin texture and tone in people with acanthosis nigricans.
• Laser therapy: Intense pulsed light therapy (IPL) or laser treatments can help in reducing the discoloration of patches associated with the condition.
• Cryotherapy: This method uses extreme cold temperatures to treat the affected skin and destroy the thickened areas.
• Chemical peels: Chemical peels involve using various acidic solutions to create a controlled burn on the skin to eliminate off pattern of surface discoloration caused by acanthosis nigricans.
• Microdermabrasion: This technique involves using a device that exfoliates the top layer of dead skin cells and helps reduce discoloration associated with acanthosis nigricans.

Generally, a dermatologist is the best type of doctor to consult for Acanthosis nigricans. Dermatologists are experts in maintaining healthy skin, and they can provide the most precise diagnosis and alternatives for care.

• Metformin: This is an anti-diabetic medication that helps to control blood sugar levels in people with type 2 diabetes. It is commonly prescribed for people with Acanthosis nigricans, as it can help to improve insulin resistance and reduce fat deposits in the skin.
• Oral Contraceptives: Certain types of oral contraceptives are prescribed for women with Acanthosis nigricans because they can help to decrease hormone levels, which in turn helps to reduce skin discoloration and thickness.
• Topical Treatments: These treatments include creams, gels, or lotions containing retinoic acid, azelaic acid, tretinoin and corticosteroids that can be applied directly to the affected areas of skin to improve its appearances.
• Anti-Obesity Medications: These medications are prescribed for patients who have been struggling with obesity and its related issues such as Acanthosis Nigricans due to insulin resistance in the body resulting from excess weight gain. Commonly prescribed drugs are Orlistat and Phentermine (Adipex).
• Other Prescription Medications: In certain cases, medications such as dapsone or cyclosporine may help treat Acanthosis nigricans by reducing inflammation causing it to disappear over time.

The time it takes to recover from Acanthosis nigricans depends on the cause of the condition. Generally, when the underlying cause is reduced or eliminated, the skin discoloration usually resolves in 1 to 2 weeks.

There is no definite cure for Acanthosis Nigricans, however it can be managed with lifestyle modifications and medical treatments. Depending on the underlying cause, treatment may be able to reverse or halt the progression of darkening, but not permanently. Overall, treatments for Acanthosis Nigricans cannot guarantee permanent results as the cause must first be determined and appropriately treated before any marked improvement can occur.

• Ensure that the patient has adequate rest after treatment: Patients should be encouraged to rest and relax for a few days after surgery. This will give their body time to recover from the stress and trauma of surgery and help them heal better.
• Supply adequate nutrition: Patients should concentrate on consuming enough of the necessary vitamins, minerals, and other nutrients since proper nutrition is crucial for recovery.
• Follow a low-impact exercise program: Exercise can help build strength in weakened muscles and improve overall health, but it should be kept to a minimum during recovery times to avoid over-stressing the affected area of the body.
• Sanitise any wound sites: Wound sites should be cleaned regularly with an antiseptic such as hydrogen peroxide or betadine in order to reduce infection risks during healing.
• Dress wounds appropriately: Patients should keep wound dressings clean while they heal and use prescribed medications if necessary. Bandages may also need to be changed periodically based on physician recommendations.
• Watch for signs of infection or reaction to medications: If a patient experiences any continued pain or swelling around surgical incisions beyond what was expected for healing; notices increasing redness around any wound; experiences fever; or has an allergic reaction from taking medications, they should seek medical attention immediately.

Depending on the severity of the ailment and the particular therapies used, the cost of Acanthosis nigricans therapy in India may vary. Generally, topical treatments such as creams, ointments, and lotions are relatively inexpensive, ranging from around 200 INR to 2000 INR.

In more severe cases, medications may be prescribed by a doctor which can cost up to 5000 INR or more. Laser therapy and other cosmetic procedures may also be used to reduce the appearance of dark patches on skin and can range from 3000 INR up to 25000 INR or higher.

• The most common side effects associated with treatment for acanthosis nigricans include skin irritation, gastrointestinal disturbances, and headaches.
• Topical treatments such as retinoids may cause drying, irritation, and redness of the skin around the affected area.
• Oral medications like glucocorticoids may also cause weight gain, nausea, abdominal pain, indigestion and abdominal bloating.
• Oral antibiotics have been linked to increased risk of infection due to reduced immunity to pathogens in the body.
• Other potential side effects associated with medications used to treat acanthosis nigricans can include dizziness, insomnia and confusion depending on individual condition and response to medication.

A doctor in your area should be consulted if you have Acanthosis nigricans consequences since they may lead to 'skin infections, type-2 diabetes, cancer, etc.,' for which the length of the treatment period will depend on how severe the condition is.