Efficacy and safety of lasers versus topical medications for acanthosis nigricans and pseudo-acanthosis nigricans treatment: a systematic review.

Acanthosis nigricans (AN) is a cutaneous disorder identified by well-defined pigmented plaques mostly detected on skin folds. Timely diagnosis and treatment of AN is essential as it could be an early manifestation of an underlying condition. The treatment of choice for AN has not been determined yet. Our study aimed to compare the efficacy and safety of various lasers with topical medications, including cream and peel. PubMed, Scopus, and Web of Science databases, as well as the Google Scholar search engine, were thoroughly searched until May 1st, 2023. Study selection was restricted to clinical trials published in English language comparing lasers with topical treatments. This study followed the PRISMA guidelines for systematic reviews and meta-analyses. Out of 1748 studies, Six clinical trials met our inclusion criteria, with 133 patients. We examined laser therapies, including fractional CO2 laser, 1550-nm erbium fiber laser, and long-pulsed alexandrite laser, while the topical treatments comprised glycolic acid (GA) peel, retinoic acid peel, trichloroacetic acid (TCA) peel, and tretinoin cream. In two studies, GA peel demonstrated favorable results compared to fractional CO2 laser. Besides, fractional CO2 laser exhibited efficacy, surpassing TCA peel in AN management. Additionally, a fractional 1550-nm erbium fiber laser displayed superiority over tretinoin cream in reducing average roughness. Similarly, a long-pulsed alexandrite laser demonstrated its effectiveness in axillary AN treatment compared to the combination of tretinoin and ammonium lactate. Overall, the findings revealed that laser therapy was associated with superior results. Moreover, topical treatments are safe and efficacious in AN management.

Acanthosis Nigricans: An Updated Review.

BACKGROUND: Early recognition of acanthosis nigricans is important because acanthosis nigricans can be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. OBJECTIVE: The purpose of this article is to familiarize pediatricians with the clinical manifestations, evaluation, diagnosis, and management of acanthosis nigricans. METHODS: A search was conducted in November 2021in PubMed Clinical Queries using the key term "acanthosis nigricans". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS: Acanthosis nigricans is characterized by symmetric, hyperpigmented, and velvety plaques with ill-defined borders, typically involving intertriginous areas. Obesity is the most common cause of acanthosis nigricans which is increasingly observed in obese children and adolescents and can serve as a cutaneous marker of insulin resistance. Early recognition of acanthosis nigricans is important because acanthosis nigricans can also be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. This may consist of weight reduction, discontinuation of causative drugs, treatment of underlying endocrinopathy, or treatment of an underlying malignancy. For patients with isolated acanthosis nigricans and for those whose underlying cause is not amenable to treatment, treatment of the lesion may be considered for cosmetic reasons. Topical retinoids, vitamin D analogs, chemical peels, and other keratolytics are often used for the treatment of localized lesions. Seldom, systemic therapy such as oral retinoids may be considered for extensive or generalized acanthosis nigricans and acanthosis nigricans unresponsive to topical therapy. Other uncommon treatment modalities include dermabrasion, laser therapy, and surgical removal. CONCLUSION: Although acanthosis nigricans is treatable, a complete cure is difficult to achieve. The underlying cause should be treated, if possible, to resolve and prevent the recurrence of acanthosis nigricans. The diagnosis is mainly clinical, based on the characteristic appearance (symmetrically distributed, hyperpigmented, velvety, papillomatous, hyperkeratotic plaques with ill-defined borders) and the typical sites (intertriginous areas, flexural area, and skin folds) of the lesions. The diagnosis might be difficult for lesions that have atypical morphology or are in an unusual location. Clinicians should be familiar with the clinical signs, evaluation, diagnosis, and therapy of acanthosis nigricans because of the link between it and underlying diseases.

Fractional carbon dioxide laser versus trichloroacetic acid peel in the treatment of pseudo-acanthosis nigricans.

BACKGROUND: Treatment of acanthosis nigricans (AN) is challenging, and new modalities are being explored continuously to increase the therapeutic efficacy. AIM: To evaluate the efficacy and safety of fractional CO2 laser compared to trichloroacetic acid (TCA) peel in the treatment of pseudo-acanthosis nigricans (pseudo-AN). METHODS: The study included 40 patients with pseudo-AN on the neck and axilla allocated into two groups each containing 20 patients. Group (A) was treated with TCA 20% peel applied on the pigmented area while group (B) received fractional CO2 laser. Both treatments were performed till complete clearance or for a maximum of four treatment sessions. Patients with excellent response were further followed up for 6 months after the end of treatment. RESULTS: Both modalities were effective in the treatment of pseudo-AN; however, the therapeutic response was significantly higher in the fractional CO2 laser group compared to the TCA peel group (p < 0.01). Marked to excellent response (51%-100% clearance of AN lesions) was achieved in 85% of the patients in the fractional laser group versus 10% of the patients in the TCA group. Adverse effects, for example, persistent erythema, post-inflammatory hyperpigmentation, and burning sensation, were also statistically higher in the TCA group compared to the laser group (p = 0.04). CONCLUSION: Fractional CO2 laser is a promising effective and well-tolerated treatment modality for pseudo-acanthosis nigricans.

Cutaneous Manifestations of Diabetes.

Diabetes mellitus is a significant worldwide health concern and cutaneous manifestations are common. This review describes characteristic skin findings of diabetes, general skin findings related to diabetes, and findings related to diabetes treatment with a focus on clinical presentation, diagnosis, pathophysiology, epidemiology, and treatment. As the prevalence of diabetes continues to rise, cutaneous manifestations of diabetes mellitus likely will be encountered more frequently by physicians in all disciplines including dermatologists and primary care physicians. Accordingly, knowledge regarding the prevention, diagnosis, and management of cutaneous manifestations is an important aspect in the care of patients with diabetes.

Acanthosis nigricans: A review.

BACKGROUND: Acanthosis nigricans (AN) is a cutaneous disorder characterized by symmetric velvety hyperpigmented plaques on intertriginous areas like axilla, neck, inframammary, and groin. AIMS: To summarize the pathophysiology and classification of AN, provide an update of diagnostic testing strategies, and describe the current therapeutic options described so far in the literature for this disease. METHODS: A comprehensive english language literature search across multiple databases (PubMed, EMBASE, MEDLINE, and Cochrane) for keywords (alone and in combination) was performed. MeSH as well as non-MeSH terms such as "acanthosis nigricans," "classification," "pathophysiology," "diagnosis," "treatment," "topical drugs," "systemic drugs," "chemical peeling," and "lasers" were taken into consideration. RESULTS: The pathophysiology of AN revolves around a multifactorial stimulation of proliferation of epidermal keratinocytes and dermal fibroblasts. Various types of AN include benign, obesity-associated, syndromic, malignant, acral, unilateral, medication-induced, and mixed-type. Homeostasis model assessment-insulin resistance (HOMA-IR) is a good tool for assessment of insulin resistance. Management involves general measures (weight reduction and addressing the underlying cause, if any), topical drugs (retinoids, vitamin D analogs, and keratolytics), oral drugs (retinoids and insulin sensitizers), chemical peels (trichloroacetic acid), and lasers (Long pulsed alexandrite, fractional 1550-nm erbium fiber, and CO2 ). CONCLUSION: Acanthosis nigricans is a treatable condition; however, complete cure and disappearance of lesions are difficult to achieve. Weight reduction is the most scientific and practical management strategy. Long-term studies and further research is warranted in the pathophysiology and treatment of this common condition.

Hyperandrogenism, insulin resistance and acanthosis nigricans (HAIR-AN syndrome): an extreme subphenotype of polycystic ovary syndrome.

HAIR-AN-a syndrome of hyperandrogenism (HA), insulin resistance (IR) and acanthosis nigricans (AN)-is a specific subphenotype of polycystic ovary syndrome (PCOS), and it is seen in almost 5% of all women with hyperandrogenism. An adolescent girl aged 11 years old was referred with adrenarche, hyperandrogenism and obesity commencing at age 8. Clinical and biochemical investigations confirmed significant hyperandrogenism and insulin resistance, and a diagnosis of HAIR-AN syndrome was made after exclusion of other differential diagnoses. HAIR-AN syndrome is an important diagnosis for the adolescent gynaecologist to be aware of, and it requires a multidisciplinary approach, including endocrinology input, for optimal management. Weight loss, lifestyle modification and combined hormonal pill and metformin are considered first-line treatment.

Intraoral acanthosis nigricans and its clinical relevance as a manifestation of a paraneoplastic syndrome: a case report / Acantosis nigricans intraoral y su relevancia clínica como manifestación de un síndrome paraneoplásico: reporte de un caso

Malignant-or-paraneoplastic acanthosis nigricans is a verrucous and hyperpigmented tumor affecting the mucosa and skin. In most cases malignant acanthosis nigricans is a distant manifestation of an intra-abdominal primary cancer. While the diagnosis of malignant acanthosis nigricans is challenging, some specific clinical and histopathological findings could lead to an accurate diagnosis. A rare clinical case of a 59-year-old female, who was referred to the maxillofacial surgery service due to a painful oral lesion in the palatine region, is presented. Upon examination, papillomatous lesions were observed on the hard palate, that were later diagnosed as intraoral malignant acanthosis nigricans secondary to gastric cancer. Both local and systemic evaluations are discussed, highlighting the relevance of a multidisciplinary approach consistent with the fact that these manifestations, although infrequent, should generate suspicion among clinicians and therefore motivation to perform a diligent and complete study since it can reveal the presence of a malignant pathology.

La acantosis nigricans maligna o paraneoplásica es un tumor verrugoso e hiperpigmentado que afecta la mucosa y la piel. En la mayoría de los casos, la acantosis nigricans maligna es una manifestación distante de un cáncer primario intraabdominal. Si bien el diagnóstico de acantosis nigricans maligna es desafiante, algunos hallazgos clínicos e histopatológicos específicos podrían conducir a un diagnóstico preciso. Se presenta un caso clínico raro de una mujer de 59 años, que fue derivada al servicio de cirugía maxilofacial debido a una lesión oral dolorosa en la región palatina. En el examen, se observaron lesiones papilomatosas en el paladar duro, que posteriormente se diagnosticaron como acantosis nigricans maligna intraoral secundaria a cáncer gástrico. Se discuten tanto las evaluaciones locales como las sistémicas, destacando la relevancia de un enfoque multidisciplinario consistente con el hecho de que estas manifestaciones, aunque poco frecuentes, deberían generar sospecha entre los clínicos y, por lo tanto, motivación para un estudio diligente y completo, ya que puede revelar la presencia de una patología maligna.

The color of skin: black diseases of the skin, nails, and mucosa.

Gradations in skin color are a consequence of differing amounts of melanin and their varying distribution. Although many darkly pigmented skin lesions are melanocytic and can be attributed to melanin content, the color of a black lesion can also be due to blood, necrotic tissue, or exogenous pigment. The source, pattern, and distribution of the color in black lesions usually offer important insight into its etiology. This contribution reviews conditions that can take on a black color, discussing the cause of the hue and any additional impact sun exposure may have.

Comparative study using fractional carbon dioxide laser versus glycolic acid peel in treatment of pseudo-acanthosis nigricans.

Pseudo-acanthosis nigricans is a common dermatological disorder that is usually difficult to treat secondary to maceration of the skin from excessive sweating, obesity, or associated with endocrine disorders. Fractional photothermolysis and chemical peeling have been reported to improve the condition. To determine whether fractional CO2 laser resurfacing or glycolic acid peel is more effective and safe option for therapy. Twenty Egyptian patients were included in the study where each patient was subjected to three sessions of both fractional CO2 on the right side of the neck and glycolic acid peel 70% on the left side of the neck. All patients were evaluated by a scoring system Acanthosis Nigricans Area and Severity Index (ANASI) score and three blinded dermatologists before and after treatment. Clinical improvement on the side treated by glycolic acid peel showed 43% improvement while the side treated by fractional CO2 showed 19% improvement. Glycolic acid peel shows superior results to fractional CO2 due to accelerated induced exfoliation, yet still fractional CO2 results are promising due to a presumably long-term improvement of skin texture.

[Paraneoplasms of the skin]. / Paraneoplasien der Haut.

The cutaneous manifestations of malignancies include nonmalignant skin disorders that occur in association with malignancies (facultative paraneoplastic dermatoses) and skin disorders that are always associated with hematologic diseases or solid tumors (obligate paraneoplastic dermatoses). Paraneoplastic increase of growth factors or immunological reactions lead to a variety of inflammatory, hyperkeratotic or proliferative skin reactions. When paraneoplastic dermatoses develop before cancer is diagnosed, recognition of these skin diseases can accelerate both the diagnosis and treatment. The presence of unexplained cutaneous findings should lead to a multidisciplinary evaluation of the patient. This manuscript summarizes the cutaneous manifestations associated with hematologic disorders and solid tumors, their localization and treatment options.

Pigmentation Disorders: Diagnosis and Management.

Pigmentation disorders are commonly diagnosed, evaluated, and treated in primary care practices. Typical hyperpigmentation disorders include postinflammatory hyperpigmentation, melasma, solar lentigines, ephelides (freckles), and café au lait macules. These conditions are generally benign but can be distressing to patients. Appropriate dermatologic history, skin examination, and skin biopsy, when appropriate, can help exclude melanoma and its precursors. In addition to addressing the underlying condition, hyperpigmentation is treated with topical agents, chemical peels, cryotherapy, light or laser therapy, or a combination of these methods. Café au lait macules are treated with surgical excision or laser therapy if treatment is desired. Hypopigmentation disorders include vitiligo, pityriasis alba, tinea versicolor, and postinflammatory hypopigmentation. Treatment of vitiligo depends on the distribution and extent of skin involvement, and includes topical corticosteroids and calcineurin inhibitors, ultraviolet A therapy (with or without psoralens), narrowband ultraviolet B therapy, and cosmetic coverage. Patients with stable, self-limited vitiligo may be candidates for surgical grafting techniques, whereas those with extensive disease may be candidates for depigmentation therapy to make skin tone appear more even. Other hypopigmentation disorders may improve or resolve with treatment of the underlying condition.

A case of acanthosis nigricans coexisting with mycosis fungoides.

Acanthosis nigricans maligna (ANM) is a paraneoplastic phenomenon most commonly associated with visceral adenocarcinoma, in particular, gastric adenocarcinoma. Clinically, AMN is characterized by rapidly progressive symmetrical skin thickening and hyperpigmentation of the intertriginous areas with peripheral acrochorda. The diagnosis is made by a detailed medical work-up for occult malignancies with particular emphasis on endocrinological diseases. We report a 67-year-old man that presented clinically with acanthosis nigricans, in which a subsequent diagnosis of mycosis fungoides was made.

Acanthosis nigricans: A fold (intertriginous) dermatosis.

Acanthosis nigricans (AN) is a mucocutaneous disorder that is characterized by focal or diffuse hyperkeratotic, surfaces, which are symmetrically distributed hyperpigmented lesions of the skin. It rarely affects mucosal surfaces like oral cavities. Although it is commonly seen in adolescents, AN is also increasingly seen in children who are obese. Recent studies have found that AN can be a cutaneous indicator of insulin resistance and malignancy. Acanthosis nigricans has been associated with type 2 diabetes mellitus, obesity, endocrinopathies, drugs, and malignancies.

Acantosis nigricans y linfoma no Hodgkin: presentación de un caso / Acanthosis nigricans and non-Hodgkin’s lymphoma: a case presentation

La acantosis nigricans fue la primera dermatosis en la que se reconoció un carácter paraneoplásico. La característica sobresaliente es la hiperpigmentación simétrica y el engrosamiento aterciopelado de la piel. Se sugiere que algún factor producido por el tumor estimula el crecimiento epidérmico.Objetivo: presentar un caso poco frecuente de un paciente con el diagnóstico de linfoma no Hodgkin y acantosis nigricans.Caso clínico: se presenta el caso de un paciente masculino de 62 años de edad con antecedentes de hipertensión arterial que un año previo a su ingreso manifestó cambios en la coloración de la piel, dermatosis generalizada, hiperpigmentación e hiperqueratosis en las palmas de las manos y el cuello.Conclusiones: el tumor más frecuente asociado con acantosis es el adenocarcinoma abdominal en 90 por ciento de los casos, entre los cuales 64 a 69 por ciento son de origen gástrico; el resto (10 por ciento ) se asocian con cáncer no digestivo; linfoma de Hodgkin, micosis fungoide, cáncer de esófago, próstata y tiroides. En el linfoma no Hodgkin su asociación es considerada muy rara y son pocos los casos reportados en la bibliografía...

Acanthosis nigricans was the first dermatosis in which a paraneoplastic nature was identified. The most significant feature is symmetrical hyperpigmentation and velvety thickening of the skin. It is suggested that any factor produced by the tumor stimulates the epidermal growth.Objective: to present the infrequent case of a patient diagnosed with non-Hodgkin’s lymphoma and acanthosis nigricans.Clinical case: the case of a sixty-two-year-old male patient with a personal history of high blood pressure is presented. A year before his admission the patient presented changes in the coloration of the skin, widespread dermatosis, hyperpigmentation and hyperkeratosis in the hands and neck.Conclusions: the most frequent tumor associated to acanthosis was abdominal adenocarcinoma, found in the 90 percent of the cases; among them a 64 to 69 percent were of gastric origin; the rest of the cases (10 percent) were associated to non-digestive cancer, Hodgkin’s lymphoma, mycosis fungoides, esophagus cancer, prostate cancer, and thyroid cancer. In relation to Hodgkin’s lymphoma, the association is considered as rare, and there are just a few cases reported in the bibliography...

Acantosis nigricans y linfoma no Hodgkin: presentación de un caso / Acanthosis nigricans and non-Hodgkins lymphoma: a case presentation

Fundamento: la acantosis nigricans fue la primera dermatosis en la que se reconoció un carácter paraneoplásico. La característica sobresaliente es la hiperpigmentación simétrica y el engrosamiento aterciopelado de la piel. Se sugiere que algún factor producido por el tumor estimula el crecimiento epidérmico.Objetivo: presentar un caso poco frecuente de un paciente con el diagnóstico de linfoma no Hodgkin y acantosis nigricans.Caso clínico: se presenta el caso de un paciente masculino de 62 años de edad con antecedentes de hipertensión arterial que un año previo a su ingreso manifestó cambios en la coloración de la piel, dermatosis generalizada, hiperpigmentación e hiperqueratosis en las palmas de las manos y el cuello.Conclusiones: el tumor más frecuente asociado con acantosis es el adenocarcinoma abdominal en 90 por ciento de los casos, entre los cuales 64 a 69 por ciento son de origen gástrico; el resto (10 por ciento ) se asocian con cáncer no digestivo; linfoma de Hodgkin, micosis fungoide, cáncer de esófago, próstata y tiroides. En el linfoma no Hodgkin su asociación es considerada muy rara y son pocos los casos reportados en la bibliografía(AU)

Background: acanthosis nigricans was the first dermatosis in which a paraneoplastic nature was identified. The most significant feature is symmetrical hyperpigmentation and velvety thickening of the skin. It is suggested that any factor produced by the tumor stimulates the epidermal growth.Objective: to present the infrequent case of a patient diagnosed with non-Hodgkins lymphoma and acanthosis nigricans.Clinical case: the case of a sixty-two-year-old male patient with a personal history of high blood pressure is presented. A year before his admission the patient presented changes in the coloration of the skin, widespread dermatosis, hyperpigmentation and hyperkeratosis in the hands and neck.Conclusions: the most frequent tumor associated to acanthosis was abdominal adenocarcinoma, found in the 90 percent of the cases; among them a 64 to 69 percent were of gastric origin; the rest of the cases (10 percent) were associated to non-digestive cancer, Hodgkins lymphoma, mycosis fungoides, esophagus cancer, prostate cancer, and thyroid cancer. In relation to Hodgkins lymphoma, the association is considered as rare, and there are just a few cases reported in the bibliography(AU)

Acanthosis nigricans in adolescents: a practical approach.

Acanthosis nigricans (AN) is a lesion affecting localized areas of the skin in persons with obesity and/or hyperinsulinemia. Biochemical mechanisms responsible for developing this hyperplastic lesion are unclear, but likely involve local cutaneous growth factors. It is associated with obesity, endocrinopathies (insulin resistance, diabetes mellitus, Cushing disease and acromegaly) and visceral malignancies. Clinicians should recognize AN because it may herald disorders ranging from endocrine disturbances to malignancy. Early recognition of these conditions is essential to identify children who are at highest risk for developing type 2 diabetes and further metabolic abnormalities.

Dermatologic manifestation of diabetes.

With the rising incidence of diabetes mellitus (DM) in the US, it is of paramount importance that practitioners understand the complications of DM and how best to manage them. Diabetes affects every organ system and the skin is no exception. There are numerous cutaneous manifestations of DM that have similar etiologies and result from the same pathologic mechanisms as the internal complications of this disease state. In addition, skin manifestations may precede the diagnosis of diabetes. The present article reviews both the common and less common cutaneous manifestations of DM, including presenting lesions, pathogenesis, and management.

Skin findings associated with obesity.

We are facing an obesity epidemic in adolescents in the United States. Thus, practitioners will need to become familiar with cutaneous findings associated with obesity in order to diagnose and treat them properly. This article addresses some of the cutaneous findings associated with obesity.