Current treatment options for acanthosis nigricans

Figures & data

Table 1 Comparison of studies of AN

Therapy	Reference	Study design	N	Subject description	Intervention	Primary outcome measure	Results
Topical therapies
Tretinoin 0.1% cream	Berger and Gross^Citation7	Case report	1	18 yo female with AN	Applied BID to neck and axillae	Subjective clinical improvement	Clearance of neck in 10 days; improvement of hyperkeratosis and color of axillae within 14 days
Tretinoin 0.1% gel	Darmstadt et al^Citation8	Case report	1	55 yo Indian male with AN onset 16 weeks after initiating nicotinic acid for dyslipidemia	Applied BID to left axilla	Subjective clinical improvement	Complete resolution after 2 weeks
Tretinoin 0.05% + hydroxyquinone 4% + fluocinolone acetonide 0.01%	Adigun and Pandya^Citation12	Case report	1	39 yo Hispanic female with AN that developed during pregnancy	Applied nightly to neck	Subjective clinical improvement	Significant improvement after 1 month
Adapalene gel	Schwartz^Citation9	Split comparison study	16	Pediatric patients (mean age 13.4 years) with AN who were at least over 85th BMI percentile for age	Daily application of 0.01% adapalene gel to target side of neck, placebo gel to opposite side of neck	Investigator (IGE) and parent (PGE) evaluation of improvement (0–6 scale), evaluation of tissue tolerance (0–4 scale), percent change of skin color ratio	Significant improvement in therapeutic side of skin color ratio at 2 and 4 weeks, improved IGE and PGE, and minimal cutaneous irritation
Calcipotriol 0.005%	Gregoriou et al^Citation16	Case report	1	77 yo male with several month history of AN	Applied BID to nape, axilla, umbilicus, groin	Subjective clinical improvement	Complete remission at 4 weeks with no relapse 6 months after stopping treatment
Trichloroacetic acid (TCA) peel	Zayed et al^Citation17	Pilot study	6	Egyptian females (mean age 31.5 years) who were Fitzpatrick type IV with AN	Weekly for 1 month, TCA 15% was applied to affected areas (neck, groin, axillae, cheek) until a deep solid frost appeared. Peels were followed by sunscreen and emollients	Subjective clinical improvement, graded response to therapy (mild, moderate, excellent)	Physician assessments were excellent in two treated areas, moderate in four and mild in four. Side effects were brief burning sensation and hyperpigmentation
Oral therapies
Isotretinoin	Katz^Citation20	Case report	1	33 yo obese female with DM type II and AN of axillae, groin, antecubital fossae, dorsa of hands, angles of mouth, inframammary folds	0.5 mg/kg/day for 1 week, increasing by 0.5 mg/kg/day weekly for 16 weeks. Due to side effects, maintenance dose was 2 mg/kg/day	Subjective clinical improvement	At 3 mg/kg/day, all affected areas had resolved, but patient reported conjunctivitis, cheilitis, and had elevated triglycerides. Lesions returned 8 weeks after discontinuation
Acitretin 0.8mg/kg	Ozdemir et al^Citation23	Case report	1	18 yo male with no significant medical history with AN across upper abdomen, lateral chest, proximal UE and entire LE	0.8 mg/kg/day for 45 days with 0.4 mg/kg/day maintenance dose	Subjective clinical improvement	Complete resolution at day 45 with mild recurrence that resolved with topical 0.1% retinoic acid applied daily
Metformin	Bellot-Rojas et al^Citation28	Randomized, open-label trial	7	Obese or overweight patients with AN of neck	Metformin (n=4) or rosiglitazone (n=3) for 12 weeks	Subjective clinical improvement	No effect on the severity of AN; modest improvements of skin texture in both groups
Octreotide	Romo and Benavides^Citation13	Case report	1	15 yo obese male with AN of neck and axillae	Octreotide 50 µg subq TID for 5.5 months	Subjective clinical improvement	Improved AN that persisted 6 months after stopping treatment
Fish oil	Sherertz^Citation34	Case report	1	18 yo female with lipodystrophic DM and AN of neck, axillae, and other body folds	Fish oil 10–20 g/day for 6 months	Subjective clinical improvement	After 1 month, there was slightly less prominent AN; after 6 months, texture and hyperpigmentation had markedly improved
Acipimox	Coates et al^Citation38	Case report	1	40 yo obese female with type V hyperlipidemia and nicotinic acid-induced AN on antecubital fossae and axillae	Substitution of acipimox 250 mg TID	Subjective clinical improvement	Complete resolution of AN within weeks with no deterioration of lipid profile
Other therapies
Alexandrite laser	Rosenbach and Ram^Citation36	Case report	1	38 yo Asian-American female with 10-year history of AN of axillae	Long-pulsed (5 msec) alexandrite laser at 16–23 J/cm^2 with spot sizes of 10 mm or 12.5 mm for 10 treatments at 4- to 8-week intervals	Subjective clinical improvement	Greater than 95% improvement after seven treatments in texture and hyperpigmentation with no recurrence at 2-year follow-up. Side effects included moderate discomfort and shallow ulcerations
Surgical removal of malignancy	Ghosh et al^Citation5	Case report	1	35 yo obese male with AN of neck and insulinoma	Surgical enucleation of the mass	Subjective clinical improvement of AN and resolution of hyperinsulinemia	At 8 weeks postoperatively, AN had resolved and insulin levels normalized

Note: Studies included are those for which full articles were accessible.

Abbreviations: AN, acanthosis nigricans; yo, year old; BID, twice daily; OCP, oral contraceptive pill; DM, diabetes mellitus; UE, upper extremity; LE, lower extremity; subq, subcutaneously; TID, three times daily.

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SherertzEFImproved acanthosis nigricans with lipodystrophic diabetes during dietary fish oil supplementationArch Dermatol19881247109410963389852

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CoatesPShuttleworthDReesAResolution of nicotinic acid-induced acanthosis nigricans by substitution of an analogue (acipimox) in a patient with type V hyperlipidaemiaBr J Dermatol199212644124141571266

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RosenbachARamRTreatment of acanthosis nigricans of the axillae using a long-pulsed (5-msec) alexandrite laserDermatologic Surg200430811581160

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GhoshSRoychowdhuryBMukhopadhyaySChowdhurySClearance of acanthosis nigricans associated with insulinoma following surgical resectionQJM20081011189990018669553

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