Acanthosis Nigricans: An Updated Review

Abstract

Background: Early recognition of acanthosis nigricans is important because acanthosis nigricans can be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. Objective: This purpose of this article is to familiarize pediatricians with the clinical manifestations, evaluation, diagnosis, and management of acanthosis nigricans. Methods: A search was conducted in November 2021 in PubMed Clinical Queries using the key term "acanthosis nigricans". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Results: Acanthosis nigricans is characterized by symmetric, hyperpigmented, velvety plaques with ill-defined borders, typically involving intertriginous areas. Obesity is the most common cause of acanthosis nigricans which is increasing observed in obese children and adolescents and can serve as a cutaneous marker of insulin resistance. Early recognition of acanthosis nigricans is important because acanthosis nigricans can also be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. The diagnosis is mainly clinical, based on the characteristic appearance (symmetrically distributed, hyperpigmented, velvety, papillomatous, hyperkeratotic plaques with ill-defined borders) and the typical sites (intertriginous areas, flexural area, and skin folds) of the lesions. Although acanthosis nigricans is treatable, complete cure is difficult to achieve. The underlying cause should be treated, if possible, to resolve and prevent recurrence of acanthosis nigricans. This may consist of weight reduction, discontinuation of causative drugs, treatment of underlying endocrinopathy, or treatment of an underlying malignancy. For patients with isolated acanthosis nigricans and for those whose underlying cause is not amenable to treatment, treatment of the lesion may be considered for cosmetic reasons. Topical retinoids, vitamin D analogs, chemical peels, and other keratolytics are often used for the treatment of localized lesions. Seldom, systemic therapy such as oral retinoids may be considered for extensive or generalized acanthosis nigricans and acanthosis nigricans unresponsive to topical therapy. Other uncommon treatment modalities include dermabrasion, laser therapy, and surgical removal. Conclusion: Although acanthosis nigricans is treatable, complete cure is difficult to achieve. The underlying cause should be treated, if possible, to resolve and prevent recurrence of acanthosis nigricans. The diagnosis is mainly clinical, based on the characteristic appearance (symmetrically distributed, hyperpigmented, velvety, papillomatous, hyperkeratotic plaques with ill-defined borders) and the typical sites (intertriginous areas, flexural area, and skin folds) of the lesions. The diagnosis might be difficult for lesions which have atypical morphology or are in an unusual location Due to the association between acanthosis nigricans and underlying pathologies, clinicians should be knowledgeable about the clinical manifestations, evaluation, diagnosis, and management of acanthosis nigricans.

Clinical factors associated with remission of obese acanthosis nigricans after laparoscopic sleeve gastrectomy: a prospective cohort study

“…However, no literature report has shown that Testo levels are crucial to bariatric surgery-induced OB_AN remission. A common mechanism for the development of OB_AN is insulin resistance 31 , and Hammarstedt et al . 32 have found that Testo plays a key role in regulating insulin resistance, so we combined the literature and our results to suggest that the remission mechanism after OB_AN surgery could be that Testo affects insulin and contributes to the improvement of OB_AN pathologies by affecting insulin.…”

Group A Streptococcal Infections in Pediatric Age: Updates about a Re-Emerging Pathogen

“…The diagnosis of post-streptococcal diseases is based on clinical history and findings compatible with the specific illness associated with the evidence of a preceding group A strep infection, including the isolation of GAS from the throat/skin or the detection of certain streptococcal antibodies (anti-streptolysin O and anti-DNase B). A four-fold increase in titer is considered the proof of antecedent streptococcal infection [27,29,33,[42][43][44].…”

“…Finally, the third group, which includes guidelines from Australia and New Zealand, identifies two groups of patients at higher risk: patients of Maori or Aboriginal ethnicity, especially people living in rural areas, characterized by overcrowding and low socioeconomic status, and those with a previous history of acute rheumatic fever aged 3-40 years old. Once a diagnosis of GAS pharyngitis is confirmed, antimicrobial therapy should be promptly initiated to prevent both suppurative and non-suppurative complications, in particular, ARF, in which case the treatment should be initiated within 9 days of symptom onset [44,45].…”

“…Furthermore, they are unlikely to transmit the infection [50]. Eradication for the GAS carrier state must be taken into account in the following risk conditions: a local outbreak of GAS sequelae, including ARF, APSGN, or iGAS disease; an outbreak of GAS pharyngitis in a closed or semiclosed community; family or personal history of acute rheumatic fever; and multiple episodes of GAS pharyngitis occurring in a family for many weeks despite appropriate treatment [42][43][44][45]49]. Antibiotic options for eradication include clindamycin, penicillin, rifampin, and amoxicillin-clavulanic acid [46].…”

Manifestações Cutâneas Em Crianças: Diagnóstico E Tratamento

“…3 Acadêmica de Medicina Pontifícia Universidade Católica de Minas Gerais -PUC Betim 4 Médica Faculdade Dinâmica do Vale do Piranga (FADIP). 5 Acadêmica de medicina Universidade do Grande Rio / Unigranrio.…”