Fractional carbon dioxide laser versus trichloroacetic acid peel in the treatment of pseudo‐acanthosis nigricans

Abstract

Acanthosis nigricans is a common pigmentary disorder characterized by hyperpigmented and hyperkeratotic velvety skin lesions that presents mainly on the flexural sites, for example, the neck, the axillae, and groin. 1 The pathogenesis is mostly attributed to increased insulin resistance and hyperinsulinemia that result in stimulation of insulin growth factor 1 (IGF-1) receptors on keratinocytes and fibroblasts, leading to cellular proliferation. The dark color of AN is mostly due to hyperkeratosis rather than an increase in melanocytes. 2 It can be simply classified into four types: benign, malignant, drug-induced, and syndromic/pseudo-acanthosis nigricans. The term pseudo-acanthosis nigricans was referred to obese individuals who have AN with no underlying endocrinopathies. In these cases, the etiology was attributed to obesity, excessive local friction, and sweat. 3 The goal of therapy in AN is to correct the underlying disorder and treatment of AN lesions through cosmetic correction of the pigmentation. 4 Several topical and systemic agents have been used in the treatment of AN, for example, tretinoin, salicylic acid,

Fractional Carbon Dioxide Laser versus Glycolic Acid Peel in Treatment of Pseudo-Acanthosis Nigricans

“…There was overall improvement in area index, severity and texture across time subjected to CO2 laser (p < 0.001). This finding is in agreement with Eldeeb et al (13) study who reported that the use of fractional CO2 laser resulted in marked improvement of both the texture and pigmentation of AN. In contrast to the current findings, Zaki et al (9) study demonstrated that the mean severity of the lesion did not improve after using CO2 laser on the right side of the neck, where the mean Acanthosis Nigricans Area and Severity Index (ANASI) at the start of the study was 23.50 ± 8.85, and after the laser treatment sessions, it became 19.10 ± 7.62, (P value = 0.1) which showed no statistical improvement.…”

“…All cases were females and mean age was 17.5 ranging from 6 to 39 years. Female preponderance was reported by Zaki et al (9) , Eldeeb et al (13) and Leerapongnan et al (12) studies. Conversely, Thomas et al (14) study has shown that AN is more prevalent in the male population [55 were male (55%) and the rest 45 were female (45%)].…”

“…In contrast to the current findings, Zaki et al (9) reported that, the clinical improvement on the side treated by glycolic acid peel was 43% when compared to 19% improvement on the laser side and there was statistical difference between both sides (P = 0.008). Additionally, a higher statistically significant improvement was found in the AN lesions treated with CO2 laser compared to TCA peels in Eldeeb et al (13) study (p < 001). This could be attributed to different peeling, laser parameters, and longer treatment duration in their study (four sessions).…”

Efficacy of Fractional Carbon Dioxide (CO2) Laser versus Q-Switched Neodymium-Doped Yttrium Aluminum Garnet (Nd:YAG) and Potassium-Titanyl-Phosphate (KTP) Lasers in the Treatment of Acanthosis Nigricans

“…The aim of treatment in AN is to treat the associated disorder and treatment of the pigmentation lesion. 16 There was a significant improvement in ANASI score and MI index in our study after fractional CO 2 laser; this can be explained by the fact of making skin columns of thermal injury known as micro-thermal zones and removing thin layers of skin with minimal thermal damage leading to collagen injury and collagen remodeling. 10 In addition, transepidermal 712 elimination of the dermal content is the possible mechanism by which melanin is eliminated.…”

“…The aim of treatment in AN is to treat the associated disorder and treatment of the pigmentation lesion. 16 …”