Acanthosis Nigricans: A Skin Marker of Internal Disease

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What is Acanthosis Nigricans?

It is a skin disorder characterized by thickening, pigmentation and a fine or rough velvety look, 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 assortment of illnesses, from obesity to cancer.

Individuals with acanthosis nigricans are recognized for their resistance to insulin in diabetes.

According to the causes, acanthosis nigricans is divided into two key types:

A. BENIGN ACANTHOSIS NIGRICANS

1. Hereditary benign acanthosis nigricans: This runs in families, but does not typically show any evidence of endocrinological disturbances or internal malignancy.
   
2. Endocrinal acanthosis nigricans: It is connected with a number of endocrine difficulties like acromegaly, addison's disease, Cushing's illnesses, insulin resistant diabetes mellitus, hypothyroidism, ovarian hyperthecosis, hepatic cirrhosis,Wilson's illness etc
   
3. Pseudo acanthosis nigricans: This is a reversible kind and often begins in puberty. It frequently affects dark skinned people and is related with obesity
   
4. Drug induced acanthosis nigricans: Nicotinic acid is notorius in causing acanthosis nigricans. Other drugs like stilbostreol, corticosteroids, oral contraceptive pills and so on can also cause acanthosis nigricans like lesions.

B. MALIGNANT ACANTHOSIS NIGRICANS(Associated with cancerous growths inside).

Internal malignancies (cancers), specially the adenocarcinomas affecting the stomach, lungs etc can cause acanthosis nigricans. Often lymphoma might be the culprit.

Hence it is essential to acquire 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 Harmful Malignant Varieties?

for an image of Acanthosis nigricans.

Onset : Benign - Birth, childhood or puberty. Malignant - Adulthood, old age

Distribution:

Extent of involvement: Benign - Much less. Malignant - Widespread

Distal extremities: Benign - Spared. Malignant - Affected

Mucous membrane involvement: Benign - Rare . Malignant - Prevalent-up to 50%

Hair, nail, palms & soles: Benign - Rare, Malignant - Widespread

Pigmentation: Benign - Less, limited to thickened areas. Malignant - Far more, extend beyond thickened locations.

Skin Thickening: Benign - Mild to moderate. Malignant - Marked

Skin Irritation: Benign - Less or nil. Malignant - A great deal more

When to Consult Dermatologist?

When the pigmentation is severe and the signs of malignancy is present as above.

Salient Points indicating presence of related internal cancer are:

• Late onset
  
• Rapid progression
  
• Severe affection
  
• Extensive distribution
  
• Mucous membrane involvement
  
• Much more symptoms like irritation and sudden look of skin tags

Suggestions On Dealing With Acanthosis Nigricans

Do's:

1. Differentiate between benign and malignant with the support of a dermatologist
   
2. Reduction of weight
   
3. Strict diabetic control
   
4. Regular aerobic exercises
   
5. Full investigations including tumor markers, hormonal assay, ultra sound scan, MRI and so on
   
6. Regular medical check up, semi annual
   
7. Report any sudden changes in morphology

Don'ts

1. Scrub too much, as frequent rubbing will only increase skin thickening and pigmentation
   
2. Use powerful abrasives: tend to irritate the skin a lot more.

Therapy 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 fatty acids have been reported to be

beneficial

three. Cyproheptadine has been discovered helpful in some instances

4. Management of Skin Lesions:

• Topical Retin A
  
• Salicylic acid application alone or in mixture with steroids, alternating with emollient applications to minimize irritation.
  
• In severe unresponsive instances, 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 soon 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 inside a few days with out any treatment! Moral: To attain cure you must excise the responsible hormone secreting tumor, not just any tumor!

Disclaimer

Data provided in this post is strictly for educational purposes and is not meant to substitute for the suggestions provided by your own dermatologist or other medical specialists. You should really not use the facts contained herein for diagnosing or treating a wellness challenge or disease, or prescribing any medication. A number of skin illnesses have comparable morphology and may possibly resemble 1 a different, although their remedy protocol varies. Hence, self diagnosis and treatment are not advised. In case of doubt at all times be on the safer side and consult your dermatologist or physician.