Sunday, March 1, 2015

Acanthosis Nigricans

PATIENT STORY
An adolescent girl with obesity and recently diagnosed type II diabetes mellitus (DM) presents to her family physician with concerns about a “dirty area” under her arms and on her neck that “couldn’t be
cleaned” (Figure). She has irregular periods that often skip several months at a time.




Acanthosis nigricans
fig :Acanthosis nigricans in the left axilla of an overweight  10-year-old girl. Note areas of dark velvety discoloration and pink filiform hypertrophy.

MANAGEMENT
NONPHARMACOLOGIC
• Patients with AN are at higher risk of metabolic syndrome, and lipid screening should be considered along with consideration of testing for DM.

• Weight loss through diet and exercise helps reverse the process, probably by reducing both IR and compensatory hyperinsulinemia.

MEDICATIONS
• Keratolytic agents (e.g., salicylic acid) can improve the cosmetic appearance. Other topical therapies, including 0.1% tretinoin cream (to lighten the lesion), combination tretinoin cream with
12% ammonium lactate cream, or topical vitamin D ointments,.

• Metformin12 and octreotide have also been used to manage AN. SOR C

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