Obesity-Associated Acanthosis Nigricans

Obesity-Associated Acanthosis Nigricans

Article
Men's Health
Skin Care
+5
Contributed byLester Fahrner, MD+1 moreMar 13, 2022

What are the other Names for this Condition? (Also known as/Synonyms)

  • Acanthosis Nigricans, Obesity-Associated Type
  • Psuedoacanthosis Nigricans (Obesity-Associated Type)
  • Obesity-Associated AN

What is Obesity-Associated Acanthosis Nigricans? (Definition/Background Information)

  • Acanthosis Nigricans (AN) is a skin condition that causes thick, velvety, and darkened skin areas (due to increased thickness of epidermis). It commonly affects the skin of the armpits, the groin region, nape of the neck (back of the neck), and anal/genital region, and knuckles
  • Acanthosis Nigricans is not contagious, and it cannot be transmitted from one individual to another. But, it is associated with many disorders, such as obesity, diabetes, and malignancy
  • Obesity-Associated Acanthosis Nigricans is one among the 7 types of Acanthosis Nigricans. It is the most common type of AN. It is observed in almost 50% of the individuals who are obese; it is especially seen in individuals with darker skin tones
  • Obesity-Associated Acanthosis Nigricans is often caused due to insulin resistance (when the activity of insulin is impaired and is not effective in the body)
  • It is usually diagnosed by a thorough clinical history, physical examination, and dermatologist consultation and testing, to rule out other causes of Acanthosis Nigricans. If obesity (or diabetes) is present or suspected, blood glucose level, HbA1c, and fasting insulin level tests may be performed
  • Metabolic syndrome, characterized by insulin resistance, does not usually show a significantly elevated glucose level that would be diagnosed as diabetes
  • The treatment for Obesity-Associated Acanthosis Nigricans is aimed at addressing obesity and the skin pigmentation condition. Certain treatment modalities may be used for cosmetic reasons. Also, treatment of any associated underlying condition is warranted and is typically undertaken
  • The prognosis of skin lesions due to Obesity-Associated Acanthosis Nigricans, as such, is excellent with no known major complication being observed

Who gets Obesity-Associated Acanthosis Nigricans? (Age and Sex Distribution)

  • Individuals of any age group can be affected by Obesity-Associated Acanthosis Nigricans, but it is most commonly seen in the adult population
  • Acanthosis Nigricans is also being increasingly reported in obese children
  • Both males and females of all races and ethnicities can be affected
  • Nevertheless, the condition is more common in individuals with darker skin tone. It is more common in Native American, African American, and Hispanic Americans, than in Caucasians or Asians
  • Acanthosis Nigricans is seen all over the world; there is no particular geographical restriction observed

What are the Risk Factors for Obesity-Associated Acanthosis Nigricans? (Predisposing Factors)

  • Overweight, obese, or type 2 diabetic individuals are at risk for Obesity-Associated Acanthosis Nigricans

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Obesity-Associated Acanthosis Nigricans? (Etiology)

  • Obesity Associated Acanthosis Nigricans can be caused due to insulin resistance, which is common in individuals with obesity and/or type 2diabetes
  • Insulin resistance results when the activity of insulin hormone is impaired at the receptors that are site of its action. Because of insulin resistance, the body secretes more insulin (a condition termed as hyperinsulinemia) as a compensatory mechanism which acts as a growth factor of the epidermis, causing it (the epidermis) to thicken
  • Some scientists also believe that these individuals may have antibodies to the insulin receptor, which causes the insulin resistance

What are the Signs and Symptoms of Obesity-Associated Acanthosis Nigricans?

The signs and symptoms of Obesity-Associated Acanthosis Nigricans include:

  • It most commonly presents as hyperpigmented, velvety, poorly-defined skin lesions, most commonly on the skin folds such as the axilla (armpits), groin, and back of the neck
  • The hyperpigmentation can be either brown or black in color. The skin lesions may cause itching and may even have a foul smell
  • Like other benign types of Acanthoses Nigricans, skin lesions appear gradually and in generally healthy individuals
  • Obesity-Associated Acanthosis Nigricans skin lesions tend to be milder when compared to other types of Acanthosis Nigricans (such as those associated with malignancy)

How is Obesity-Associated Acanthosis Nigricans Diagnosed?

The following procedures may be used to diagnose Obesity-Associated Acanthosis Nigricans:

  • Thorough evaluation of the individual’s medical history and a complete physical examination
  • During history-taking, the physicians may enquire about the following:
    • When the symptoms began and whether they are becoming worse
    • List of prescription and over-the-counter medications currently being taken
    • About one’s personal and family history of cancer, diabetes, thyroid abnormalities, ovarian and adrenal gland problems, etc.
  • Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
  • Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
  • If obesity or diabetes is present or suspected, screening by checking for fasting blood glucose or HbA1C levels may be suggested
  • Measuring insulin levels in blood may be necessary, if insulin resistance is suspected. The insulin levels in such individuals may be high
  • A skin biopsy (of the affected skin area) is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: A skin biopsy is only rarely performed, when the diagnosis is questionable, or if it resembles other similar skin conditions.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Obesity-Associated Acanthosis Nigricans?

Complications due to Obesity-Associated Acanthosis Nigricans may include:

  • The skin lesions of AN generally do not cause any medically-related problems, but it can result in low self-esteem due to cosmetic concerns
  • Children who develop Acanthosis Nigricans have a greater tendency to develop type 2 diabetes mellitus later in their life

How is Obesity-Associated Acanthosis Nigricans Treated?

Treatment measures for Obesity-Associated Acanthosis Nigricans may include the following:

  • Dermatologist consultation: It is often necessary, as they are the experts in dealing with various skin conditions
  • Treatment of the underlying obesity and/or diabetes is essential; it is generally considered to be more important than treating the skin lesions alone
    • If diabetes is the underlying cause of Acanthosis Nigricans, appropriate management of diabetes through suitable lifestyle modifications is essential
    • When obesity is the underlying cause, weight loss management is recommended
  • Topical retinoid, bleaching cream, dermabrasion therapy, and long-pulsed alexandrite laser skin therapy are used for addressing the cosmetic issues only. However, they are not a definitive treatment for Acanthosis Nigricans
  • If AN presents with bad odor, then antibacterial soap or antibiotic cream may be helpful
  • In individuals with insulin resistance, physicians may prescribe appropriate medications. Sometimes, dietary fish oils may also be prescribed

How can Obesity-Associated Acanthosis Nigricans be Prevented?

In Obesity-Associated Acanthosis Nigricans, the skin lesions can be prevented and/or controlled through appropriate blood sugar control and weight reduction, and by ensuring suitable lifestyle modifications (dietary control and physical exercises).

What is the Prognosis of Obesity-Associated Acanthosis Nigricans? (Outcomes/Resolutions)

  • In general, Acanthosis Nigricans is a skin sign, which in itself is benign. Thus, the prognosis of Acanthosis Nigricans is excellent with adequate (skin) treatment. However, the overall prognosis depends upon the underlying cause of the condition
  • The prognosis of Obesity-Associated Acanthosis Nigricans is generally excellent with appropriate therapy. However, it also depends upon the severity of the underlying diabetes and/or obesity
  • With suitable weight loss measures and control of blood sugar, the skin lesions are known to recede or decrease in severity

Additional and Relevant Useful Information for Obesity-Associated Acanthosis Nigricans:

  • When the biopsied skin tissue is seen by a pathologist under the microscope, the lesions may demonstrate a benign epidermis with hyperkeratosis, papillomatosis, thickening of epidermis (Acanthosis), hyperkeratosis, increased number of melanocytes (melanocytic hyperplasia), and lymphocytic inflammation
  • Interestingly, there are only fewer acanthosis with no hyperpigmentation that do not fit the histologic terminology. The hyperpigmented appearance is actually due to hyperkeratosis
  • Microscopically, all the seven types of Acanthoses Nigricans share similar features
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On the Article

Krish Tangella MD, MBA picture
Approved by

Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team
Lester Fahrner, MD picture
Reviewed by

Lester Fahrner, MD

Chief Medical Officer, DoveMed Team

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