Treatment of acanthosis nigricans with sequential salicylic acid‐mandelic acid combination peel and maintenance with glycolic acid‐urea combination cream: A retrospective pilot study

Abstract

Background Acanthosis nigricans (AN) is a common dermatosis that presents with hyperpigmented, velvety thick plaques over intertriginous areas. Though a number of treatment modalities including chemical peels have been used, none provide long‐term and sustained improvement. Aim and objectives Our study evaluated the efficacy and safety of regular sessions of salicylic acid‐mandelic acid peeling over axillary AN lesions, which was followed by daily application of a topical combination of glycolic acid, urea, and cetylated fat esters for maintenance of effect for 9 months. Methodology A retrospective pilot study was conducted in Indian patients (Fitzpatrick skin type 4 or 5), aged 18–50 with benign hereditary AN involving the underarms, with or without affection of other typical sites. Data were retrieved of seventeen patients with AN involving the axillae. Patients were started on combination salicylic‐mandelic acid peel given every 2 weeks for a total of 6 sessions. Maintenance was done by night application of combination cream of glycolic acid, urea, and cetylated fat esters, which was continued for 9 months after completion of peeling sessions. Lesions were evaluated every 3 months of 9 months for improvement in pigmentation and skin thickening. Results All the patients (100%) showed significant improvement in both pigmentation and thickening of lesions. In terms of improvement in skin thickening, very good improvement was seen in 41%, while 29% patients had moderate improvement. In terms of improvement in pigmentation, 35% each had very good and moderate improvement. Post peel erythema (100%) and burning sensation (90%) were the most common encountered adverse effects which lasted for only 1–2 days. Patients were followed up for another 9 months during which no relapses were seen. Conclusion Combination of keratolytic chemical peels and topical mild keratolytic application ensures better therapeutic outcome in patients of AN with long lasting effect.

A comparison of the efficacy and safety profiles of 10% salicylic acid and 10% urea creams in treating acanthosis nigricans in adolescents: a randomized double-blinded study

“…In our study, there is no placebo arm used; the equal efficacy of both treatments may lead to the explanation that there is no statistically significant difference between the groups. In addition, another study on subjects has revealed that a combination of keratolytic chemical peels and mild keratolytic applications ensure promising results on skin improvement of AN [ 12 ]. Further studies may focus on different concentrations or combinations of other creams for increased effectiveness to reduce skin hyperpigmentation.…”

Evaluating the Efficacy and Safety of Alpha-Hydroxy Acids in Dermatological Practice: A Comprehensive Clinical and Legal Review

“…Patients with acanthosis nigricans were investigated in a retrospective study by Zeeshan et al, 69 who compared salicylic-mandelic acid and maintenance with GA-urea combination cream. One hundred percent of patients saw a reduction in lesion thickness and an increase in pigmentation.…”

Comparison of efficacy and safety of tretinoin 0.05% and glycolic acid peeling 70% in axillary and neck lesions of acanthosis nigricans: A single‐blinded, randomized trial

“…Additionally, procedures such as fractional and alexandrite lasers have been established as treatment modalities for this purpose. [9][10][11][12] Ultimately, the drug of choice for AN has not yet been determined, and further trials are required to demonstrate the effectiveness of various modalities. In this single-blinded, randomized trial, we aimed to evaluate the effectiveness of tretinoin 0.05% which is considered the first-line treatment for AN, and to compare it with a 70% glycolic acid peeling solution.…”

“…These include topical treatments such as retinoids, chemical peels, and calcipotriol, as well as oral agents like oral retinoids and fish oil. Additionally, procedures such as fractional and alexandrite lasers have been established as treatment modalities for this purpose 9–12 …”