Acanthosis nigricans
Summary
Definition
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].
História e exame físico
Principais fatores diagnósticos
- 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
- generalized distribution
- sudden appearance of multiple seborrheic keratoses
Outros fatores diagnósticos
- age >40 years
- child/young adult
- female sex
- acrochordons (skin tags)
- acral distribution
- pruritus
- mucosal or palmoplantar lesions
- weight loss
Fatores de risco
- obesity
- insulin resistance
- positive family history of AN or genetic syndrome
- family history of diabetes mellitus
- malignancy
- medication
Investigações diagnósticas
Investigações a serem consideradas
- fasting blood glucose
- fasting blood insulin
- abdominal CT
- skin biopsy
Algoritmo de tratamento
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
Declarações
DSC declares that he has no competing interests.
Agradecimentos
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
Christine Ko, MD
Assistant Professor of Dermatology
Department of Dermatology
Yale University
New Haven
CT
Declarações
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
Declarações
JE declares that he has no competing interests.
Créditos aos pareceristas
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
Das A, Datta D, Kassir M, et al. Acanthosis nigricans: a review. J Cosmet Dermatol. 2020 Aug;19(8):1857-65. Resumo
Schwartz RA. Acanthosis nigricans. J Am Acad Dermatol. 1994 Jul;31(1):1-19. Resumo
Patel NU, Roach C, Alinia H, et al. Current treatment options for acanthosis nigricans. Clin Cosmet Investig Dermatol. 2018 Aug 7:11:407-13.Texto completo Resumo
Artigos de referência
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Diagnósticos diferenciais
- Epidermal nevus
- Dowling-Degos disease (reticular pigmented flexural anomaly)
- Confluent and reticulated papillomatosis (of Gougerot and Carteaud)
Mais Diagnósticos diferenciais
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