Drug‐induced acanthosis nigricans: A systematic review and new classification

Abstract

Drug-induced acanthosis nigricans is an uncommon subtype of acanthosis nigricans and the data on this topic is not well understood by clinicians as it is presently limited in the literature. Previous reports of drug-induced acanthosis nigricans have simply consisted of a list of drugs possibly implicated in causing acanthosis nigricans. Several drugs listed are based on single case reports without biopsy confirmation, report of clearing on stopping the drug or reporting on whether acanthosis nigricans recurred with drug rechallenge. A comprehensive literature search was conducted using PubMed, EMBASE(Ovid), Cochrane Library, Scopus, and Web of Science electronic databases. The authors screened the initial result of the search strategy by title and abstract using the following inclusion criteria: eligible studies included those with patients who developed acanthosis nigricans secondary to a drug. This study is the first to comprehensively review the drugs that have been implicated in the development of acanthosis nigricans. A total of 38 studies were included in the systematic review, and a total of 13 acanthosis nigricans inducing drugs were identified. Nicotinic acid and insulin were the two most significant drugs that were reported to cause acanthosis nigricans. By using the results of this study, we created a revised classification system of drug-induced acanthosis nigricans which can be used as a concise framework for clinicians to refer to.

Acanthosis nigricans in a patient with metastatic insulinoma post peptide receptor radionuclide therapy

“…AN may be associated with endocrine disorders including acromegaly, gigantism, polycystic ovarian syndrome, Cushing’s syndrome and type 2 diabetes. Medications such as glucocorticoids, insulin and estrogen can exacerbate hyperinsulinemia and lead to iatrogenic AN ( 3 ). In this setting, AN can resolve with improvement in insulin resistance via weight loss or by cessation of the offending medication ( 1 ).…”

An Overview of Clinical Manifestations of Dermatological Disorders in Intensive Care Units: What Should Intensivists Be Aware of?

“…It is a dark discolored hyperkeratotic velvet-like skin condition with plaques in body folds and creases (e.g., groin, axillae, neck) [ 107 ]. It is usually associated with hyperinsulinemia (present in obesity and type 2 diabetes mellitus), the use of systemic corticosteroids, nicotinic acid, diethylstilbestrol, and isoniazid, or it can be an indicator of underlying adenocarcinoma, particularly gastrointestinal, where it has a sudden onset and a wide distribution that includes the face, palms, and trunk [ 108 ].…”

Physical Examination for Endocrine Diseases: Does It Still Play a Role?

“…The pathogenesis depends on hyperinsulinemia, which directly and indirectly stimulates the IGF1 receptor (IGF1R) on the surface of keratinocytes and fibroblasts, stimulating their proliferation [31]. Adequate pharmacological anamnesis might also be useful in the clinical characterization of this sign, since the use of drugs that cause hyperinsulinemia, such as glucocorticoids, niacin, estrogen-progestogen therapies, and protease inhibitors, may lead to its appearance [44]. In addition to metabolic syndrome and obesity, acanthosis nigricans may be present in some other endocrine diseases that impair glucose metabolism.…”