Acanthosis nigricans

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Ogheneochuko Ajari, MB.BS, MS [2], Cafer Zorkun, M.D., Ph.D. [3], Jesus Rosario Hernandez, M.D. [4]

Overview

Acanthosis nigricans is a brown to black, poorly defined, velvety hyperpigmentation of the skin, usually present in the posterior and lateral folds of the neck, the axilla, groin, umbilicus, and other areas. Acanthosis nigricans generally occurs due to insulin spillover (from excessive production due to obesity or insulin resistance) onto the skin which results in abnormal skin growth The most common cause of acanthosis nigricans is insulin resistance, usually from type 2 diabetes mellitus.Involvement of mucous membranes is rare and suggests a coexisting malignant condition.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

• Diabetes mellitus
• Drug-induced
• Gastric cancer
• Idiopathic
• Insulin resistance
• Obesity
• Polycystic ovary syndrome

Causes by Organ System

Cardiovascular	Congenital generalized lipodystrophy type 1, congenital generalized lipodystrophy type 2
Chemical / poisoning	No underlying causes
Dermatologic	Peroxisome proliferator-activated receptor disorders, melanoma, Beare-Stevenson cutis gyrata syndrome, hyperpigmentation, congenital generalized lipodystrophy type 1, congenital generalized lipodystrophy type 2
Drug Side Effect	Glucocorticoids, growth hormone therapy, insulin , niacin , oral contraceptives, protease inhibitors
Ear Nose Throat	No underlying causes
Endocrine	Acromegaly, Donohue syndrome, prediabetes, hypothyroidism, Addison's disease, hyperandrogenism, Bangstad syndrome, Cushing's disease, diabetes mellitus type 2, diabetes mellitus, insulin resistance with acanthosis nigricans type A, familial partial lipodystrophy type 2, hyperthyroidism, insulin receptor defect, metabolic syndrome, polycystic ovary syndrome, Rabson-Mendenhall syndrome, peroxisome proliferator-activated receptor disorders, congenital generalized lipodystrophy type 1, congenital generalized lipodystrophy type 2
Environmental	No underlying causes
Gastroenterologic	Colon cancer, liver cancer, stomach cancer, congenital generalized lipodystrophy type 1, congenital generalized lipodystrophy type 2
Genetic	Crouzon syndrome with acanthosis nigricans, crouzonodermoskeletal syndrome, familial, FGFR3 mutation, severe achondroplasia with developmental delay and acanthosis nigricans, Beare-Stevenson cutis gyrata syndrome, Donohue syndrome, Bangstad syndrome, familial partial lipodystrophy type 2, Rabson-Mendenhall syndrome, peroxisome proliferator-activated receptor disorders, congenital generalized lipodystrophy type 1, congenital generalized lipodystrophy type 2
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	Acromegaly, Crouzon syndrome with acanthosis nigricans, crouzonodermoskeletal syndrome, severe achondroplasia with developmental delay and acanthosis nigricans, Beare-Stevenson cutis gyrata syndrome, Donohue syndrome, Bangstad syndrome, familial partial lipodystrophy type 2, Rabson-Mendenhall syndrome, congenital generalized lipodystrophy type 1, congenital generalized lipodystrophy type 2
Neurologic	Hyperglycemia, severe achondroplasia with developmental delay and acanthosis nigricans, Bangstad syndrome, congenital generalized lipodystrophy type 2
Nutritional / Metabolic	Obesity, metabolic syndrome, hyperglycemia, peroxisome proliferator-activated receptor disorders, Rabson-Mendenhall syndrome, Bangstad syndrome, congenital generalized lipodystrophy type 1, congenital generalized lipodystrophy type 2
Obstetric/Gynecologic	Ovarian cancer, ovarian cyst, uterine cancer, breast cancer, hyperandrogenism, polycystic ovary syndrome
Oncologic	Breast cancer, lung cancer, prostate cancer, melanoma, colon cancer, liver cancer, stomach cancer, ovarian cancer, uterine cancer
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Lung cancer
Renal / Electrolyte	Addison's disease, Cushing's disease, hyperglycemia, hyperandrogenism
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	Prostate cancer
Miscellaneous	No underlying causes

Causes in Alphabetical Order

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Diagnosis

Physicians can usually diagnose acanthosis nigricans by simply looking at a patient's skin. A skin biopsy may be needed in unusual cases. If no clear cause of acanthosis nigricans is obvious, it may be necessary to search for one. Blood tests, an endoscopy, or x-rays may be required to eliminate the possibility of diabetes or cancer as the cause.

Physical Examination

Skin

Neck

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  Acanthosis nigricans. With permission from Dermatology Atlas.

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  Acanthosis nigricans. With permission from Dermatology Atlas.

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  Acanthosis nigricans. With permission from Dermatology Atlas.

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  Acanthosis nigricans. With permission from Dermatology Atlas.

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  Acanthosis nigricans. With permission from Dermatology Atlas.

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  Acanthosis nigricans. With permission from Dermatology Atlas.

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  Acanthosis nigricans. With permission from Dermatology Atlas.

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  Acanthosis nigricans. With permission from Dermatology Atlas.

Axillae

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  Acanthosis nigricans. With permission from Dermatology Atlas.

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  Acanthosis nigricans. With permission from Dermatology Atlas.

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  Acanthosis nigricans. With permission from Dermatology Atlas.

Pseudoacanthosis Nigricans

Neck

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  Pseudo-acanthosis nigricans. With permission from Dermatology Atlas.

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  Pseudo-acanthosis nigricans. With permission from Dermatology Atlas.

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  Pseudo-acanthosis nigricans. With permission from Dermatology Atlas.

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  Pseudo-acanthosis nigricans. With permission from Dermatology Atlas.

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  Pseudo-acanthosis nigricans. With permission from Dermatology Atlas.

Treatment

People with acanthosis nigricans should be screened for diabetes and, although rare, cancer. Controlling blood glucose levels through exercise and diet often improves symptoms.

Prognosis

Acanthosis nigricans often fades if the underlying cause can be determined and treated appropriately.

External Links

• AOCD
• Template:Chorus