Tag Archives: Acanthosis Nigricans

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.

*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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A Herald of Diabetes

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The young woman who walked in for a consultation had a scarf wound around her neck. “I came to show you this,” she said, taking it off. There was a dark patch on the back of her neck with ridges and bumps, the skin raised and velvety. “I have already tried fairness creams,” she said. “They only make it worse.”
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The diagnosis was easy. She had a peculiar skin lesion known as acanthosis nigricans.

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The cosmetically disfiguring and aesthetically displeasing lesions usually occur on the neck (where they are clearly visible), armpit, groin, knees or elbows, in short areas with skin folds. Very rarely, it can be found on the fingers or around the lips or in the nipple area. It can occur at any age and in both men and women. It is seen in children and even in babies. The lesions appear gradually and do not itch or pain. This means that they remain unnoticed until they have spread over a large area. Initially it looks like dirt so people try to scrub it off, damaging the skin in the process. Others try to camouflage it unsuccessfully with talcum powder and make up.

Nearly 20 per cent of the population has acanthosis nigricans and the numbers are rising rapidly because obesity is the commonest risk factor. More and more people are becoming overweight in India and the world.

An inactive lifestyle causes weight gain and these two factors together cause relative insulin resistance, which results in elevated glucose levels, an abnormal lipid profile and high blood pressure. These changes are grouped together as the “metabolic syndrome X”. Acanthosis nigricans is one of the early markers of this syndrome. The American diabetic association classified it as a risk factor for the development of diabetes in 2000. In children and adolescents, symptoms of syndrome X or frank diabetes begin to appear within two years of the appearance of acanthosis nigricans.

The disease can also be hereditary and in typical inherited acanthosis nigricans, skin lesions are confined to one half of the body. They spread and increase till a certain age and then remain stationery or regress. In other families the lesions, though present in almost all family members, are not really hereditary. The biggest difference is that they are present on both sides of the body. The family usually has an inactive lifestyle, members are obese and go on to develop diabetes.

Medications can also cause these skin changes as a side effect. The most common offenders are hormones — like oral contraceptive pills (OCP), hormone replacement therapy (HRT), insulin, pituitary extract, growth hormone or systemic corticosteroids. Unfortunately, pituitary extract or steroids may be added to unregulated “natural herbal supplements” or “tonics” so the person may not even know that he or she is ingesting such substances. Sulpha drugs (antibiotic)and nicotinic acid (for high cholesterol) can also cause these.

Certain types of acanthosis nigricans are peculiar to women. It is associated with the polycystic ovary syndrome and appears at adolescence. Such girls are obese and have irregular periods and facial hair.

If you develop acanthosis nigricans, it is worthwhile consulting a physician. Although you may be obese, and that is the commonest cause of these skin changes, some investigations and tests need to be done. This is because the skin changes can (though this is rare) be associated with cancer, particularly in the abdomen. It can appear before any other obvious sign of a tumour. It can also be a part of the spectrum of autoimmune diseases like systemic lupus erythematosus, scleroderma, Sjögren syndrome, or Hashimoto thyroiditis.

There really is no specific treatment for the skin changes in acanthosis nigricans. The disease itself is harmless. The main danger lies in the complications associated with obesity and insulin resistance. Tackling the underlying problem makes the skin lesions fade. Here is what you can do to tackle it:

• If it is due to medication or health supplements, stop taking them.

• Reduce your weight with diet and exercise. Try to reach your ideal body weight (height in meter squared multiplied by 23).

• Eat more protein, fresh fruits and vegetables. Starches and sugars provide empty calories and aggravate insulin resistance.

• Sweat trapped in the folds can make the lesions malodorous. Bathe twice a day with a medicated soap like Neko if that is the case.

Evening primrose oil or fish oil supplements may help.

• Some prescription creams or lotions help lighten the affected areas. These contain modified vitamin A products and are often prescribed for acne.

• Fairness creams do not help.

• Surgical dermal abrasion can be done.

Source:  The Telegraph ( Kolkata, India)

 

Some Health Quaries & Answers

Go back to nature



Q: I use a treadmill to exercise regularly. I always get a pain in my calves and thighs afterwards. It is very discouraging and makes me want to stop.

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A: Treadmills are excellent machines to use for exercise. Unfortunately, the movements are different from natural movement on the ground because the surface you are running on moves along with you. This results in slightly different groups of muscles in the leg being used and a different running style from the natural form. This may account for the pain you develop. The pain can be tackled by doing warm-up exercises before you hit the treadmill and cool down exercises such as flexion and stretching afterwards. Alternatively, you can go back to the natural form and run on the road.

Cosmetic cure?


Q: Although I am only 30 years old I look much older. My face is wrinkled and pimply and I have a prominent jawline. I am ashamed of the way I look. Should I go in for cosmetic surgery?

A: You are very young and I do not think cosmetic surgery or Botox is the answer. In another 10 years the same things will recur, making the cosmetic surgery a waste of time and money.

You need to jog, cycle or at least walk for an hour a day. Then do 20 minutes of yoga. Stress levels will decrease and you will be able to cope with the demands of your work. The exercise will also improve the muscle tone of your face and the rest of your body. Also, practise smiling whenever you are sitting and do not let your mouth and face droop down.

Ovarian cancer

Q: I get an itchy white discharge soon after my periods. I am afraid it may be a sign of cancer. My mother died of ovarian cancer.

A: Ovarian cancer is rare and accounts for only 1.5 per cent of cancers in women. The incidence increases to 6 per cent if there is a first degree relative with the disease. What you have described sounds more like a yeast (monilia) infection, which is common and can be easily treated with both topical applications, pessaries and /or oral tablets. Consult a gynaecologist. Get an ultrasound scan of the pelvis done to reassure yourself about the size, position and function of the ovaries.

Black mark

Q: The skin of my neck, armpit and elbow are black in colour. It does not itch nor is it painful. It just looks as though I have not had a proper bath.

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A: That is probably Acanthosis Nigricans, velvety black, non-itchy lesions which can occur in the neck, arm pit, groin and elbow. It is associated with obesity and diabetes . Get yourself tested for diabetes. If you are overweight, try to exercise and lose weight. Avoid using powder or cream . It will get aggravated.

Period problem

Q: I do not get my periods even after a year unless I take tablets. Recently I noticed a milky white discharge from both breasts as well. My parents want me to get married. My grandmother says everything will become alright if I have a baby.

A: You obviously have a problem and that is why your menstruation is not spontaneous and there is discharge from the nipple. You need to consult a gynaecologist and / endocrinologist. They will check your hormone levels — LH, FSH, prolactin and thyroid.

Shampoo right


Q: I have oily hair. I shampoo it every day but now the hair has become very brittle and is breaking off. It seems to be coming out by the handful.

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A: Oil on the scalp protects it from injury. If you use harsh shampoos the hair will get damaged. There is a right way and a wrong way of shampooing. A small quantity of a mild shampoo should be taken in the palm of the hand. The two palms should be rubbed together and the shampoo applied on the surface of the head. It should be washed off immediately and a conditioner for greasy hair should be applied on the surface of the hair. The conditioner should be left in for about five minutes before being washed off.

Hair loss can occur owing to hormone imbalance, iron, zinc or calcium deficiency.

Source : The Telegraph ( kolkata, India)