Comparing the efficacy and safety profiles of 0.025% and 0.05% tretinoin creams in treating acanthosis nigricans: a randomized double-blinded study.

Acanthosis nigricans (AN) is a skin disorder with hyperpigmented and velvety plaques without a standardized treatment regimen. We aimed to compare the efficacy and safety profile of 0.025% and 0.05% tretinoin creams in managing AN. An 8-week, randomized double-blinded study was conducted in adults with AN. Participants were instructed to apply tretinoin cream on their posterior neck. Narrowband reflectance spectrophotometry was used to measure skin improvement through melanin (M) and erythema (E) indices at each follow-up visits at weeks 2, 4, and 8. Improvements in Acanthosis nigricans scoring chart (ANSC), investigator- and patient-global evaluation (IGE and PGE) and adverse cutaneous irritations were also scored. Both the 0.025% and 0.05% tretinoin creams were efficacious in acanthosis nigricans treatment with 17.1 ± 8.0% improvement and 18.4 ± 9.8% improvement after 8 weeks treatment by reflectance spectrophotometry measurement, respectively. There were generally no significant differences in efficacy, improvements in ANSC, IGE, and PGE scores, and local cutaneous irritations between the two groups. The 0.025% and 0.05% tretinoin demonstrate similar efficacy and safety profiles in the management of AN. Both concentrations are well tolerated with mild degree of local cutaneous irritation.

Drug-induced acanthosis nigricans: A systematic review and new classification.

Drug-induced acanthosis nigricans is an uncommon subtype of acanthosis nigricans and the data on this topic is not well understood by clinicians as it is presently limited in the literature. Previous reports of drug-induced acanthosis nigricans have simply consisted of a list of drugs possibly implicated in causing acanthosis nigricans. Several drugs listed are based on single case reports without biopsy confirmation, report of clearing on stopping the drug or reporting on whether acanthosis nigricans recurred with drug rechallenge. A comprehensive literature search was conducted using PubMed, EMBASE(Ovid), Cochrane Library, Scopus, and Web of Science electronic databases. The authors screened the initial result of the search strategy by title and abstract using the following inclusion criteria: eligible studies included those with patients who developed acanthosis nigricans secondary to a drug. This study is the first to comprehensively review the drugs that have been implicated in the development of acanthosis nigricans. A total of 38 studies were included in the systematic review, and a total of 13 acanthosis nigricans inducing drugs were identified. Nicotinic acid and insulin were the two most significant drugs that were reported to cause acanthosis nigricans. By using the results of this study, we created a revised classification system of drug-induced acanthosis nigricans which can be used as a concise framework for clinicians to refer to.

Case of exogenous insulin-derived acanthosis nigricans caused by insulin injections.

A 73-year-old male with diabetes mellitus had been treated with insulin for six years. He developed a solid mass on his left lateral of the abdomen at the insulin injection site. A firm subcutaneous mass with dark-red erythema was overlaid by dark-brown keratinized plaques. On histological examination of the mass, keratin proliferation and epidermal papilloma were observed. There were four previously reported cases of acanthosis nigricans that were considered to be caused by continuous injections of insulin. Using immunohistochemistry, in our case the findings were positive in the basal epithelial and prickle cell layers when the patient's lesion was dyed with insulin-like growth factor (IGF)-1 antibody. The coexistence of dermal IGF-1 receptor and acanthosis nigricans found in our patient has not been reported previously, to our knowledge.

A case of hyperpigmentation and acanthosis nigricans by testosterone injections.

Drug-related skin disorders may occur in many different ways. Despite pigmentary changes being less important for morbidity, these changes precipitate depressed mood and reduce self-confidence. Testosterone is a steroid hormone from the androgen group and primarily used for the treatment of hypogonadism in males. Testosterone replacement can cause skin problems like acne, hair loss, redness, pain, or infection at the injection site. The study was conducted on a 49-year-old man with adult onset idiopathic hypogonadotropic hypogonadism, which is an acquired form of isolated gonadotropin-releasing hormone deficiency. He was presented with lack of energy and decreased sexual function 10 years ago and was given an oil-based injectable blend of four esterized testosterone compounds as hormone replacement treatment in a urology polyclinic. He was referred to our polyclinic by endocrinologist because of progressive hyperpigmentation marked on his face and oral mucosa. In the present study, we report the first testosterone therapy-related facial and oral mucosal hyperpigmentation and acanthosis nigricans in the same patient.

Acanthosis nigricans during treatment with aripiprazole.

Aripiprazole is typically regarded as a metabolically sparing agent, in contrast to other second-generation antipsychotics, which are widely known to lead to weight gain and increase the cardiometabolic risk. We report for the first time the emergence of Acanthosis nigricans, a dermatological correlate of insulin resistance, during treatment with aripiprazole in an adolescent with a family history of diabetes mellitus.

[Acral acanthosis nigricans associated with taking growth hormone]. / Acantosis nigricans de tipo acral asociada a la toma de hormona de crecimiento.

Acanthosis nigricans is a skin lesion characterized by the presence of a hyperpigmented, velvety cutaneous thickening that usually appears in flexural areas. Less frequently, it can occur in other locations, such as the dorsum of hands and feet. In this case it is called acral acanthosis nigricans. It is a dermatological manifestation of systemic disease. It is often associated with insulin resistance-mediated endocrine diseases. A case is presented on a patient with acanthosis nigricans secondary to the use of growth hormone.

Coexistence of insulin-derived amyloidosis and an overlying acanthosis nigricans-like lesion at the site of insulin injection.

A 59-year-old patient with diabetes mellitus had been treated with human recombinant insulin for 4 years. He developed a solid mass on his left abdomen at the insulin injection site, which had an overlying pigmented verrucous plaque and keratinized papules, similar to acanthosis nigricans (AN). On histological examination, the mass was found to contain a deposit of amyloid in the dermis, with hyperkeratosis, papillomatosis and acanthosis in the epidermis. Using immunohistochemistry, the amyloid deposits were found to be positive for insulin. A few cases of localized insulin-derived amyloid deposits at injection sites have been reported previously, but none had significant epidermal changes. The coexistence of dermal insulin-derived amyloidosis and an overlying AN-like change, as found in our patient, has not been reported previously, to our knowledge. The presence of a tumour-like lesion at the injection site should be carefully examined, as injection of insulin into amyloid deposits can result in insulin resistance.

Acanthosis nigricans in the setting of niacin therapy.

We report the case of a 63-year-old obese man with a rapid-onset of widespread acanthosis nigricans (AN) in the setting of having recently initiated treatment with niacin for dyslipidemia. Although obesity and insulin-resistance are risk factors for AN, AN associated with endocrine dysfunction tends to have a more gradual onset and limited involvement. Owing to our patient's age, the rapid onset, and extensive distribution of his eruption, we initially were concerned about paraneoplastic AN. However, an evaluation for a malignant condition was negative. The timing of the onset of our patient's eruption within several months of starting niacin therapy is consistent with niacin-induced AN. Niacin is known to cause rapidly progressive, widespread AN that is reversible upon discontinuation of the medication. We discuss the pathogenesis of AN, which is thought to be the final common manifestation of stimulation of different subtypes of tyrosine kinase receptors by various epidermal growth factors.

Acanthosis nigricans as a local cutaneous side effect of repeated human insulin injections.

Acanthosis nigricans is a hyperkeratotic lesion of the epidermis associated with insulin resistance. We present a diabetic patient with acanthosis nigricans at the insulin injection site on the abdominal wall. Neglecting rotation of sites for insulin injections and local hyperinsulinemia may play a role in the development of acanthosis nigricans.

Acanthosis nigricans in a patient treated with palifermin.

Palifermin is a modified human keratinocyte growth factor (KGF) given to decrease the incidence and duration of severe oral mucositis in patients receiving myelotoxic chemotherapy followed by a hematopoietic stem cell transplant. We report a case of a 42-year-old man who developed acanthosis nigricans after taking palifermin.

Acanthosis nigricans as an adverse effect of highly active antiretroviral therapy in an adolescent girl with human immunodeficiency virus infection.

We report an 11-year-old girl with acanthosis nigricans that appeared after 4 years of treatment with didanosine, stavudine and amprenavir. Laboratory studies showed hyperglycemia, hyperinsulinemia and hypertriglyceridemia. Withdrawal of amprenavir resulted in disappearance of acanthosis nigricans and improvement of metabolic abnormalities.