Acanthosis nigricans
Resumen
Definición
Acanthosis nigricans (AN) is a cutaneous disorder manifested by symmetric, hypertrophic, papillomatous, velvety, hyperpigmented plaques commonly found on flexural and intertriginous areas.[1] It is associated with a wide array of medical conditions. AN may present at birth or in early childhood with a familial association, but is most commonly associated with obesity and an insulin-resistant state.[2][3][4][5][6][7] Obesity-associated AN correlates with increasing body mass index, female sex, and Hispanic or black ethnicity.[5] Malignancy-associated AN is rare and most often occurs with gastric adenocarcinoma, but may also be secondary to other carcinomas and lymphomas.[8][9][10][Figure caption and citation for the preceding image starts]: Acanthosis nigricans involving the axilla of an obese Caucasian womanFrom the collection of Melvin Chiu, MD [Citation ends].
Anamnesis y examen
Principales factores de diagnóstico
- presence of risk factors
- black or Hispanic ancestry
- new pigmented velvety skin lesions in axillary or flexural areas
- lesions distributed on the posterior neck, axillae, vulva, umbilicus, inner thighs, and groin
- weight gain
- generalised distribution
- sudden appearance of multiple seborrhoeic keratoses
Otros factores de diagnóstico
- age >40 years
- child/young adult
- female sex
- acrochordons (skin tags)
- acral distribution
- pruritus
- mucosal or palmoplantar lesions
- weight loss
Factores de riesgo
- obesity
- insulin resistance
- positive family history of AN or genetic syndrome
- family history of diabetes mellitus
- malignancy
- medication
Pruebas diagnósticas
Pruebas diagnósticas que deben considerarse
- fasting blood glucose
- fasting blood insulin
- abdominal CT
- skin biopsy
Algoritmo de tratamiento
initial presentation with underlying cause
unresolved despite treatment of underlying cause, or hereditary or idiopathic
Colaboradores
Autores
David S. Cassarino, MD, PhD
Consultant Dermatopathologist
Southern California Permanente Medical Group
Sunset Medical Center
Los Angeles
CA
Divulgaciones
DSC declares that he has no competing interests.
Agradecimientos
Dr David Cassarino would like to gratefully acknowledge Dr Laura Westerling for her contribution to this topic. LNW declares that she has no competing interests.
Revisores por pares
Christine Ko, MD
Assistant Professor of Dermatology
Department of Dermatology
Yale University
New Haven
CT
Disclosures
CK declares that she has no competing interests.
John English, MBBS, FRCP
Consultant Dermatologist
Department of Dermatology
Queen's Medical Centre
Nottingham University Hospitals
Nottingham
UK
Disclosures
JE declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Das A, Datta D, Kassir M, et al. Acanthosis nigricans: a review. J Cosmet Dermatol. 2020 Aug;19(8):1857-65. Abstract
Schwartz RA. Acanthosis nigricans. J Am Acad Dermatol. 1994 Jul;31(1):1-19. Abstract
Patel NU, Roach C, Alinia H, et al. Current treatment options for acanthosis nigricans. Clin Cosmet Investig Dermatol. 2018 Aug 7:11:407-13.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Epidermal naevus
- Dowling-Degos disease (reticular pigmented flexural anomaly)
- Confluent and reticulated papillomatosis (of Gougerot and Carteaud)
More Differentials
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