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Chapter 66: Acanthosis Nigricans

Henriette De La Garza; Poom Visutjindaporn; Neelam A. Vashi

ACANTHOSIS NIGRICANS

Therapeutic Approach

Acanthosis nigricans is described as a cutaneous disorder characterized by darkening and thickening of the skin along with velvety appearance. It occurs mainly in the folds of the skin including the axillae, inframammary, groin, and neck. Acanthosis nigricans can be a cutaneous sign of an underlying condition or disease and is associated with obesity and diabetes. Very rarely, it can be a warning sign of an internal malignancy. Treatment is largely focused on addressing the underlying disease process. Dermatologic treatment aims to improve the appearance of the skin focusing on reducing the hyperkeratosis, skin lightening, and decreasing odor and discomfort. See Table 66-1.

Table 66-1Acanthosis Nigricans Treatment Table
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Table 66-1 Acanthosis Nigricans Treatment Table
MEDICATION NAME INDICATION MECHANISM OF ACTION DOSING ADVERSE EFFECTS SUGGESTED MONITORING LEVEL OF EVIDENCE (REFERENCE)
Topical Therapy
Tretinoin AN Reduction of keratinocyte proliferation, correction of hyperkeratosis and reduction of epidermal thickness

0.025% cream QD

0.05% cream QD

0.1% tretinoin gel BID

 Skin irritation None

IB1

IIB2

III3
Adapalene AN Reduction of keratinocyte proliferation, correction of hyperkeratosis and reduction of epidermal thickness 0.1% gel QD Skin irritation None IB4-5
Tazarotene AN Downregulation of keratinocyte differentiation and proliferation 0.05% cream QD Skin irritation, burning, itching None IIb6
Calcipotriol AN Inhibit keratinocyte proliferation 0.005% ointment BID Skin irritation None III7
Triple combination cream AN Inhibits melanocyte metabolic processes, epidermal and dermal turnover Tretinoin 0.05%, hydroquinone 4%, fluocinolone acetonide 0.01% cream QD Itching, burning, irritation, dyspigmentation None III8
Trichloroacetic acid AN Necrosis of epidermal layers, activation of wound repair mechanisms 15% QW Erythema, burning, skin sensitivity None IB9
Ammonium lactate + tretinoin AN Peeling and release of desmogleins from desmosomes causing disintegration 12% lotion BID, 0.05% cream QD Skin irritation, itching None III10
Urea AN Proteolytic and keratolytic 10% cream BID Skin irritation None IB1
Salicylic acid AN Reduce keratinocyte adhesion 50% q2wk Skin irritation, erythema, intense exfoliation, crusting, dryness None III11
Glycolic acid AN Keratolytic, targets the corneosome by enhancing breakdown and decreasing cohesiveness 70% q2wk Skin irritation, erythema, itching, peeling, dryness None III12
Systemic Therapy
Isotretinoin AN Normalization of epithelial growth and differentiation 1-3 mg/kg QD Teratogenic, skin dryness, nausea, increased lipids and liver enzymes CBC, CMP, lipid panel, LFTs, pregnancy test (in the United States) at baseline, after 1-2 mo, then at 2-3 mo intervals III13
Acitretin AN Normalization of epithelial growth and differentiation 0.8 mg/kg BID Teratogenic, skin dryness, nausea, increased lipids and liver enzymes CBC, CMP, lipid panel, LFTs, pregnancy test at baseline, after 1-2 mo, then at 2-3 mo intervals III14
Etretinate AN Normalization of epithelial growth and differentiation 1.0 mg/kg QD Teratogenic, skin dryness, nausea, increased lipids and liver enzymes CBC, CMP, lipid panel, LFTs, pregnancy test at baseline, after 1-2 mo, then at 2-3 mo intervals III...

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