Drug-Induced Acanthosis Nigricans

Drug-Induced Acanthosis Nigricans

Article
Men's Health
Skin Care
+2
Contributed byLester Fahrner, MD+1 moreMay 26, 2022

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

  • Drug-Induced AN
  • Medication-Induced Acanthosis Nigricans

What is Drug-Induced 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, head and neck (back of the neck), and anal/genital region
  • Acanthosis Nigricans is not contagious and it cannot be transmitted from one individual to another. It is associated with many disorders, such as obesity, diabetes, and malignancy
  • Drug-Induced Acanthosis Nigricans is one among the 7 types of Acanthosis Nigricans. It occurs as a side effect to having medications, such as oral contraceptive pills, steroids, niacin (nictonic acid), and many other medications
  • Drug-Induced Acanthosis Nigricans is usually diagnosed by a thorough clinical history and physical examination. Even though it is a benign condition, dermatologist consultation and testing is necessary to rule out other causes of Acanthosis Nigricans
  • Stopping the offending medication most of the times causes the skin lesions to disappear. Hence, the prognosis of Drug-Induced Acanthosis Nigricans is generally excellent with no known major complications being noted

Who gets Drug-Induced Acanthosis Nigricans? (Age and Sex Distribution)

  • Drug-Induced Acanthosis Nigricans is caused by the usage of certain medications. Any individual taking such medication may be at risk for the condition
  • It can affect both males and females
  • There is no predilection to any ethnic group or a particular race; the condition is observed worldwide

What are the Risk Factors for Drug-Induced Acanthosis Nigricans? (Predisposing Factors)

The key risk factor for Drug-Induced Acanthosis Nigricans is the use of certain drugs or creams that cause the condition as a side effect. The following medications are the known risk factors for causing Drug-Induced Acanthosis Nigricans:

  • Steroids
  • Nicotinic acid (niacin)
  • Estrogen, oral contraceptive pills
  • Protease inhibitors
  • Insulin
  • Hormones preparations

Note: The above medications are the most common offenders, although there are many other medications that may cause the same effect.

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 Drug-Induced Acanthosis Nigricans? (Etiology)

Drug-Induced Acanthosis Nigricans is caused by:

  • Medications, such as steroids, nicotinic acid (niacin), estrogen, oral contraceptive pills, insulin, protease inhibitors, and certain hormones
  • The condition can be defined as an adverse reaction of the body to certain medications that are used for various conditions. This results in the formation of lesions on the skin
  • Scientists believe these medications cause increased levels of insulin secretion, which plays a part in the development of Acanthosis Nigricans (like in the other types)

What are the Signs and Symptoms of Drug-Induced Acanthosis Nigricans?

The signs and symptoms of Drug Induced Acanthosis Nigricans include:

  • It most commonly presents as hyperpigmented, velvety, poorly defined skin lesions, most commonly on the skin folds such as axilla, groin, and back of the neck
  • The hyperpigmentation can be either brown or black in color
  • These individuals are usually healthy
  • The severity of the signs and symptoms may be related to usage of the drug

How is Drug-Induced Acanthosis Nigricans Diagnosed?

The following may be used to diagnose Drug Induced 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.
  • Since certain types of Acanthosis Nigricans can be associated with cancer, diabetes, or obesity, and hence, workup for these conditions may be indicated if clinical conditions warrant the same
  • 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 Drug-Induced Acanthosis Nigricans?

The skin lesions of Drug-Induced Acanthosis Nigricans generally do not cause any medically-related problems, but it can result in low self-esteem due to cosmetic concerns.

How is Drug-Induced Acanthosis Nigricans Treated?

The treatment measures for Drug induced Acanthosis Nigricans may include the following:

  • Dermatologist consultation: It is often necessary, as they are the experts in dealing with various skin conditions
  • Stopping the offending medication many a times can help resolve the condition
  • Workup for cancer, obesity, or diabetes is necessary, if clinical condition warrants it, or if the skin lesions do not regress following discontinuation of the medication
  • Treatment for cosmetic reasons may be required if the skin lesions persist despite discontinuation of medication

How can Drug-Induced Acanthosis Nigricans be Prevented?

Drug-Induced Acanthosis Nigricans may not be prevented from occurring. However, discontinuing the medication (or the use of alternative medications) will most likely resolve the skin condition.

What is the Prognosis of Drug-Induced Acanthosis Nigricans? (Outcomes/Resolutions)

The prognosis of Drug-Induced Acanthosis Nigricans is excellent with no known major complications, on discontinuation of the offending medication.

Additional and Relevant Useful Information for Drug-Induced 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 Acanthosis 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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