Medicines for Acanthosis nigricans

What it is

Acanthosis nigricans is a skin condition in which patches of skin become darker, thicker, and velvety in texture. It usually appears in the folds and creases of the body — most commonly the armpits, the back and sides of the neck, and the groin, and sometimes other areas. The patches are often symmetrical (affecting both sides), and the skin may feel soft or velvety, sometimes with skin tags nearby. Acanthosis nigricans itself is not harmful or contagious, but it is important because it is often a sign of something else going on in the body. The most common association is with insulin resistance and conditions related to it — particularly being overweight or obese, type 2 diabetes (or being at risk of it), and conditions such as polycystic ovary syndrome (PCOS). Less commonly, it can be linked with certain hormonal conditions, some medicines, or, rarely, with an internal cancer (particularly when it appears suddenly, is extensive, or occurs in an older adult without the usual risk factors), which is why sudden or unusual acanthosis nigricans should be assessed. Because acanthosis nigricans is usually a marker of an underlying issue (most often insulin resistance related to weight), the main approach is to identify and address the underlying cause — for example, managing weight, addressing insulin resistance or diabetes, or treating a hormonal condition — which can improve the skin, along with skin treatments to improve the appearance if wanted. The key messages are that acanthosis nigricans is dark, velvety skin patches (usually in body folds) that is itself harmless but often a sign of insulin resistance or another condition, and that treating the underlying cause is the main approach.

How it is treated

Acanthosis nigricans is managed mainly by identifying and treating the underlying cause, with skin treatments to improve appearance where wanted. Because it is usually a marker of an underlying condition — most often insulin resistance related to being overweight, or type 2 diabetes or PCOS — assessment focuses on looking for and addressing the cause: this may include checking for diabetes or insulin resistance, assessing weight and related health, and considering hormonal conditions or medicines, guided by a GP. Addressing the underlying cause is the key to improving the skin: for the common weight- and insulin-related cases, losing weight (where relevant) and improving insulin sensitivity (through diet, activity, and managing diabetes) can improve or reduce the skin changes over time; treating a hormonal condition (such as PCOS), or reviewing a contributing medicine, helps where relevant. For the appearance of the skin itself, treatments such as certain creams (for example those that help exfoliate or lighten the skin) may be used to improve it, and good skin care and gentle cleansing help. Importantly, because acanthosis nigricans can, uncommonly, be associated with an internal cancer — particularly if it appears suddenly, is extensive or severe, affects unusual areas, or occurs in an older adult without the usual risk factors — such presentations should be assessed to exclude an underlying cause. The reassuring messages are that acanthosis nigricans is itself harmless and not contagious, that it is usually a sign of insulin resistance related to weight (which can be improved by addressing the cause), and that sudden or unusual cases should be checked; so seeing a GP to identify and treat the underlying cause is the main step.