Highlights & Basics
- Acanthosis nigricans is a benign skin disease which often reflects an underlying medical condition.
- Most commonly associated with obesity and insulin resistance.
- Rarely, cases may be related to underlying malignancy and, where no other association is identified, malignancy screening is warranted.
- Treatment is usually unnecessary unless lesions are extensive or cosmetically unacceptable and do not resolve with treatment of the underlying condition.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
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Citations
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.[Abstract][Full Text]
1. Das A, Datta D, Kassir M, et al. Acanthosis nigricans: a review. J Cosmet Dermatol. 2020 Aug;19(8):1857-65.[Abstract]
2. Schwartz RA. Acanthosis nigricans. J Am Acad Dermatol. 1994 Jul;31(1):1-19.[Abstract]
3. Curth HO. Classification of acanthosis nigricans. Int J Dermatol. 1976 Oct;15(8):592-3.[Abstract]
4. Berk DR, Spector EB, Bayliss SJ. Familial acanthosis nigricans due to K650T FGFR3 mutation. Arch Dermatol. 2007 Sep;143(9):1153-6.[Abstract]
5. Brickman WJ, Binns HJ, Jovanovic BD, et al. Acanthosis nigricans: a common finding in overweight youth. Pediatr Dermatol. 2007 Nov-Dec;24(6):601-6.[Abstract]
6. Kong AS, Williams RL, Rhyne R, et al. Acanthosis nigricans: high prevalence and association with diabetes in a practice-based research network consortium-a PRImary care Multi-Ethnic network (PRIME Net) study. J Am Board Fam Med. 2010 Jul-Aug;23(4):476-85.[Abstract][Full Text]
7. Maguolo A, Maffeis C. Acanthosis nigricans in childhood: a cutaneous marker that should not be underestimated, especially in obese children. Acta Paediatr. 2020 Mar;109(3):481-7.[Abstract]
8. Moore RL, Devere TS. Epidermal manifestations of internal malignancy. Dermatol Clin. 2008 Jan;26(1):17-29.[Abstract]
9. Curth HO. Cancer associated with acanthosis nigricans: a review of the literature and report of a case of acanthosis nigricans with cancer of the breast. Arch Surg. 1943 Dec;47(6):517-52.
10. Rigel DS, Jacobs MI. Malignant acanthosis nigricans: a review. J Dermatol Surg Oncol. 1980 Nov;6(11):923-7.[Abstract]
11. Brown J, Winkelmann RK. Acanthosis nigricans: a study of 90 cases. Medicine. 1968 Jan;47(1):33-51.[Abstract]
12. Ramirez-Amador V, Esquivel-Pedraza L, Caballero-Mendoza E, et al. Oral manifestations as a hallmark of malignant acanthosis nigricans. J Oral Pathol Med. 1999 Jul;28(6):278-81.[Abstract]
13. Dyrszka H, Sanghavi B, Peddamatham K, et al. Esophageal involvement in acanthosis nigricans. NY State J Med. 1984 May;84(5):256-8.[Abstract]
14. Sinha S, Schwartz RA. Juvenile acanthosis nigricans. J Am Acad Dermatol. 2007 Sep;57(3):502-8.[Abstract]
15. Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: skin physiology and skin manifestations of obesity. J Am Acad Dermatol. 2007 Jun;56(6):901-16.[Abstract]
16. Kong AS, Williams RL, Smith M, et al. Acanthosis nigricans and diabetes risk factors: prevalence in young persons seen in southwestern US primary care practices. Ann Fam Med. 2007 May-Jun;5(3):202-8.[Abstract][Full Text]
17. Mukhtar Q, Cleverly G, Voorhees RE, et al. Prevalence of acanthosis nigricans and its association with hyperinsulinemia in New Mexico Adolescents. J Adolesc Health. 2001 May;28(5):372-6.[Abstract]
18. Stawczyk-Macieja M, Szczerkowska-Dobosz A, Nowicki R, et al. Malignant acanthosis nigricans, florid cutaneous papillomatosis and tripe palms syndrome associated with gastric adenocarcinoma. Postepy Dermatol Alergol. 2014 Feb;31(1):56-8.[Abstract][Full Text]
19. Torley D, Bellus GA, Munro CS. Genes, growth factors and acanthosis nigricans. Br J Dermatol. 2002 Dec;147(6):1096-101.[Abstract]
20. Koyama S, Ikeda K, Sato M, et al. Transforming growth factor-alpha (TGF alpha)-producing gastric carcinoma with acanthosis nigricans: an endocrine effect of TGF alpha in the pathogenesis of cutaneous paraneoplastic syndrome and epithelial hyperplasia of the esophagus. J Gastroenterol. 1997 Feb;32(1):71-7.[Abstract]
21. Hermanns-Le T, Scheen A, Pierard GE. Acanthosis nigricans associated with insulin resistance: pathophysiology and management. Am J Clin Dermatol. 2004;5(3):199-203.[Abstract]
22. Platsidaki E, Vasalou V, Gerodimou M, et al. The association of various metabolic parameters with multiple skin tags. J Clin Aesthet Dermatol. 2018 Oct;11(10):40-3.[Abstract][Full Text]
23. Schwartz RA. Acral acanthosis nigricans (acral acanthotic anomaly). J Am Acad Dermatol. 2007 Feb;56(2):349-50.[Abstract]
24. Hud JA Jr, Cohen JB, Wagner JM, et al. Prevalence and significance of acanthosis nigricans in an adult obese population. Arch Dermatol. 1992 Jul;128(7):941-4.[Abstract]
25. Ersoy-Evans S, Sahin S, Mancini AJ, et al. The acanthosis nigricans form of epidermal nevus. J Am Acad Dermatol. 2006 Oct;55(4):696-8.[Abstract]
26. Curth HO. Unilateral epidermal nevus resembling acanthosis nigricans. Br J Dermatol. 1976 Oct;95(4):433-6.[Abstract]
27. Kim YC, Davis MD, Schanbacher CF, et al. Dowling-Degos disease (reticulate pigmented anomaly of the flexures): a clinical and histopathologic study of 6 cases. J Am Acad Dermatol. 1999 Mar;40(3):462-7.[Abstract]
28. Lim JH, Tey HL, Chong WS. Confluent and reticulated papillomatosis: diagnostic and treatment challenges. Clin Cosmet Investig Dermatol. 2016 Aug 25:9:217-23.[Abstract][Full Text]
29. Palomeque FE, Hairston MA Jr. Confluent and reticulated papillomatosis of Gougerot and Carteaud. Arch Dermatol. 1965 Jul;92(1):49-51.[Abstract]
30. Cerroni L. Mycosis fungoides-clinical and histopathologic features, differential diagnosis, and treatment. Semin Cutan Med Surg. 2018 Mar;37(1):2-10.[Abstract][Full Text]
31. Willemze R, Scheffer E, Van Vloten WA. Mycosis fungoides simulating acanthosis nigricans. Am J Dermatopathol. 1985 Aug;7(4):367-71.[Abstract]
32. Richard G, Ringpfeil F. Ichthyoses, erythrokeratodermas and related disorders. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 5th ed. Edinburgh: Mosby; 2024:785-6.
33. Oh JS, Kang, MS, Yu HJ, et al. Familial acanthosis nigricans showing ichthyosiform skin lesions in two sisters. J Dermatol. 2007 Sep;34(9):680-1.[Abstract]
34. Bossuyt L, Morren M, Degreef H. Transient acanthosis-nigricans-like dermatosis in re-epithelializing lesions of pemphigus foliaceus. Dermatology. 1992;185(4):309-10.[Abstract]
35. Usui K, Kondo A, Nakagawa H. Pemphigus vulgaris associated with transient acanthosis nigricans like lesion. J Dermatol. 1998 Aug;25(8):550-2.[Abstract]
36. Patel NU, Roach C, Alinia H, et al. Current treatment options for acanthosis nigricans. Clin Cosmet Investig Dermatol. 2018 Aug 7:11:407-13.[Abstract][Full Text]
37. Romo A, Benavides S. Treatment options in insulin resistance obesity-related acanthosis nigricans. Ann Pharmacother. 2008 Jul;42(7):1090-4.[Abstract]
38. Ghane Y, Heidari N, Hosseini S, et al. Efficacy and safety of lasers versus topical medications for acanthosis nigricans and pseudo-acanthosis nigricans treatment: a systematic review. Lasers Med Sci. 2024 Jan 23;39(1):44.[Abstract]
39. Rosenbach A, Ram R. Treatment of Acanthosis nigricans of the axillae using a long-pulsed (5-msec) alexandrite laser. Dermatol Surg. 2004 Aug;30(8):1158-60.[Abstract]
40. Bredlich RO, Krahn G, Kunzi-Rapp K, et al. Continuous-wave carbon dioxide laser therapy in pseudoacanthosis nigricans. Br J Dermatol. 1998 Nov;139(5):937-8.[Abstract]
41. Wedge CC, Rootman DS, Hunter W, et al. Malignant acanthosis nigricans. A case report. Ophthalmology. 1993 Oct;100(10):1590-2.[Abstract]
42. Blobstein SH. Topical therapy with tretinoin and ammonium lactate for acanthosis nigricans associated with obesity. Cutis. 2003 Jan;71(1):33-4.[Abstract]
43. Omar HA, Logsdon S, Richards J. Clinical profiles, occurrence, and management of adolescent patients with HAIR-AN syndrome. ScientificWorldJournal. 2004 Jul 8;4:507-11.[Abstract]
44. Dai WS, LaBraico JM, Stern RS. Epidemiology of isotretinoin exposure during pregnancy. J Am Acad Dermatol. 1992 Apr;26(4):599-606.[Abstract]
45. Lammer EJ, Chen DT, Hoar RM, et al. Retinoic acid embryopathy. N Engl J Med. 1985 Oct 3;313(14):837-411.[Abstract]
46. National Teratology Information Service. Exposure to isotretinoin during pregnancy. Newcastle upon Tyne, England: National Teratology Information Service, Regional Drug and Therapeutics Centre, 2001.
47. Chan A, Hanna M, Abbott M, et al. Oral retinoids and pregnancy. Med J Aust. 1996 Aug 5;165(3):164-7.[Abstract]
48. Salpeter SR, Greyber E, Pasternak GA, et al. Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD002967.[Abstract][Full Text]
49. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2015 Jan 13;58(3):429-42.[Abstract][Full Text]
50. US Food and Drug Administration. FDA drug safety communication: FDA revises warnings regarding use of the diabetes medicine metformin in certain patients with reduced kidney function. April 2016 [internet publication].[Full Text]
51. Tan NKW, Tang A, MacAlevey NCYL, et al. Risk of suicide and psychiatric disorders among isotretinoin users: a meta-analysis. JAMA Dermatol. 2024 Jan 1;160(1):54-62.[Abstract][Full Text]
52. US Food and Drug Administration. iPLEDGE risk evaluation and mitigation strategy (REMS). Nov 2023 [internet publication].[Full Text]
53. Medicines and Healthcare products Regulatory Agency. Oral retinoids: pregnancy prevention-reminder of measures to minimise teratogenic risk. Dec 2014 [internet publication].[Full Text]
54. Retinoids: EMA updated warnings. Drug Ther Bull. 2018 Apr;56(4):40.
