Acanthosis nigricans

Definition:
Acanthosis nigricans is a fairly common skin pigmentation disorder.It is a brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds, such as the posterior and lateral folds of the neck, the armpits, groin, navel, forehead, and other areas.

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Types:
This is conventionally divided into benign and malignant forms., although may be divided into syndromes according to cause.

*Benign This may include obesity-related, hereditary, and endocrine forms of acanthosis nigricans.

*Malignant. This may include forms that are associated with tumour products and insulin-like activity, or tumour necrosis factor.

An alternate classification system still used to describe acanthosis nigricans was proposed in 1994 by dermatologist Schwartz. This classification system delineates acanthosis nigricans syndromes according to their associated syndromes, including benign and malignant forms, forms associated with obesity and drugs, acral acanthosis nigricans, unilateral acanthosis nigricans, and mixed and syndromic forms.

Acanthosis nigricans may be a sign of a more serious health problem such as pre-diabetes. The most effective treatments focus on finding and resolving medical condition at the root of the problem. Fortunately, these skin patches tend to disappear after successfully treating the root condition.

Signs and symptoms:
Acanthosis nigricans may present with thickened, relatively darker areas of skin on the neck, armpit and in skin folds.These patches may also appear on the groin, elbows, knees, knuckles, or skin folds. Lips, palms, and soles of the feet.

Causes:
It typically occurs in individuals younger than age 40, may be genetically inherited, and is associated with obesity or endocrinopathies, such as hypothyroidism, acromegaly, polycystic ovary disease, insulin-resistant diabetes, or Cushing’s disease.

This occurs when epidermal skin cells begin to rapidly reproduce. This abnormal skin cell growth is most commonly triggered by high levels of insulin in the blood. In rare cases, the increase in skin cells may be caused by medications, cancer, or other medical conditions, as describe below.

*Too Much Insulin
The most frequent trigger for acanthosis nigricans is too much insulin in your bloodstream. Here’s why.

When you eat, your body converts carbohydrates into sugar molecules such as glucose. Some of this glucose is used for energy while the rest is stored. In order to use the glucose for energy, insulin must also be used. The insulin enables the glucose to enter the cells.

Overweight people tend to develop resistance to insulin over time. So although the pancreas is making insulin, the body cannot use it properly. This creates a buildup of glucose in the bloodstream, which can result in high levels of both blood glucose and insulin in your bloodstream.

Excess insulin causes normal skin cells to reproduce at a rapid rate. For those with dark skin, these new cells have more melanin. This increase in melanin produces a patch of skin that is darker than the skin surrounding it. Thus, the presence of acanthosis nigricans is a strong predictor of future diabetes. If this is indeed the cause, it is relatively easy to correct with proper diet, exercise, and blood sugar control.

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*Medications:
Acanthosis nigricans can also be triggered by certain medications such as birth control pills, human growth hormones, thyroid medications, and even some body-building supplements. All of these medications can cause changes in insulin levels. Medications used to ease the side effects of chemotherapy have also been linked to acanthosis nigricans. In most cases, the condition clears up when the medications are discontinued.

Some Other Causes:(Potential but rare)

#stomach cancer (gastric adenocarcinoma)
#adrenal gland disorders such as Addison’s disease
#disorders of the pituitary gland
#low levels of thyroid hormones
#high doses of niacin

Diagnosis:
Acanthosis nigricans is typically diagnosed clinically.It is easy to recognize by sight. The doctor may want to check for diabetes or insulin resistance as the root cause. These tests may include blood glucose tests or fasting insulin tests. Your doctor may also review all your medications to see if they are a contributing factor.

It is important to inform the doctor of any dietary supplements, vitamins, or muscle-building supplements you may be taking in addition to your prescription medications.

In rare cases, the doctor may perform other tests such as a small skin biopsy to rule out other possible causes.

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. Acanthosis nigricans maligna may resolve if the causative tumor is successfully removed.

Cosmetic treatments exist for cases that are especially unsightly or embarrassing. Dark patches may be covered up with cosmetics or lightened with prescription skin lighteners. Although these treatments are not as effective as treating the root cause of the condition, they can provide some relief. Available skin lighteners include Retin-A, 20 percent urea, alpha hydroxy acids, and salicylic acid.

Prognosis:
Acanthosis nigricans often fades if the underlying cause can be determined and treated  properly.

 

Prevention:
Maintaining a healthy lifestyle & exercisIng regularly can usually prevent Acanthosis nigricans. Losing weight, controlling your diet, and, perhaps adjusting any medications that are contributing to the condition are all crucial steps. Healthier lifestyle choices will also reduce your risks for many other types of illnesses.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.healthline.com/health/acanthosis-nigricans#Definition
http://en.wikipedia.org/wiki/Acanthosis_nigricans

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