Acanthosis Nigricans: Ultimate Guide to Causes, Treatments & Prevention Tips

Acanthosis nigricans is a fairly common skin pigmentation disorder characterized by dark patches of skin with a thick, velvety texture. The affected areas of your skin may also itch or have an odor. While acanthosis nigricans itself isn't a disease, it can be a symptom of another condition like diabetes and an indicator that you may need to seek medical attention.

What is Acanthosis Nigricans?

Acanthosis nigricans (AN) is a skin disorder that results in light-brown-to-black spots. The markings look like a spot or stain that you might think you can scrub off. But washing will not remove acanthosis nigricans (AN). Acanthosis nigricans isn’t a standalone condition, so its possible complications depend on the underlying cause. If diabetes has spiked insulin levels, as is often the case, you may be at risk of the other complications of diabetes. These may include nerve damage and vision problems. Acanthosis nigricans is easy to recognize by sight.

Oftentimes, it can be like a canary in a coal mine, signifying other health conditions related to insulin resistance, such as diabetes or obesity. The presence of acanthosis nigricans is a strong predictor of future diabetes. Researchers don’t know how often it occurs in America. Acanthosis nigricans is more than just a skin condition. Acanthosis nigricans is a rare disease. Acanthosis nigricans is relatively common, affecting approximately 20% of the US population.

Where Acanthosis Nigricans Appears

The velvety markings that are characteristic of acanthosis nigricans (a-can-THO-sis NIH-grih-cans) can appear anywhere on the body. These patches may appear on skin folds and other areas, such as the following:

Armpits
Back of your neck
Groin, particularly in creases and skin folds
Elbows
Face
Knees
Knuckles
Lips
Navel
Palms
Soles of the feet
Underneath female breasts

Causes And Risk Factors For Acanthosis Nigricans

Acanthosis nigricans skin patches occur when epidermal skin cells begin to reproduce rapidly. This atypical skin cell growth is most commonly triggered by high levels of insulin in the blood. In rare cases, the increase in skin cells may be caused by medications, cancer, or other medical conditions.

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Acanthosis nigricans is frequently linked to insulin resistance. This resistance happens when the body does not respond effectively to insulin, which may contribute to an increase in skin cell reproduction and, ultimately, the formation of skin patches. Insulin resistance is also a precursor to type 2 diabetes, suggesting a complex relationship between this skin condition and metabolic disorders. As this condition is closely related to metabolic disorders, associated conditions may include those increasing cardiovascular disease risk.

Insulin and Acanthosis Nigricans

The most frequent trigger for acanthosis nigricans is an excess of insulin in your bloodstream. When you eat, your body converts carbohydrates into sugar molecules, such as glucose. Your cells use some of this glucose for energy, while your body stores the rest. The hormone insulin must allow glucose to enter cells so that the cells can use glucose for energy.

People with overweight tend to develop resistance to insulin over time. Although the pancreas makes insulin, the body can’t use it efficiently. This creates a buildup of glucose in the bloodstream, which can lead to high levels of both blood glucose and insulin in your bloodstream.

Excess insulin causes skin cells to reproduce at a rapid rate. For people with skin that has more pigment, these new cells have more melanin. This increase in melanin produces a patch of skin that’s darker than the skin surrounding it.

Medications and Supplements That Can Trigger Acanthosis Nigricans

Certain medications can trigger acanthosis nigricans, such as:

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Injected supplementary insulin
Nicotinic acid
Birth control pills
Diethylstilbestrol
Human growth hormones
Systemic glucocorticoids
Thyroid medications
Some bodybuilding supplements
Protease inhibitors
Estrogen

All of these medications can cause changes in insulin levels. The condition clears up when you stop taking the medications. It’s important to tell your doctor about any dietary supplements, vitamins, or bodybuilding supplements you may be taking in addition to any prescription medications.

Other Potential Causes of Acanthosis Nigricans

In rare cases, acanthosis nigricans can occur due to:

Stomach cancer, or gastric adenocarcinoma
Adrenal gland disorders, such as Addison’s disease
Disorders of the pituitary gland
Low levels of thyroid hormones
High doses of niacin
Some types of stomach cancer
Genetics
Some autoimmune disorders like Sjögren’s disease or Hashimoto’s thyroiditis

Who Is at Risk for Acanthosis Nigricans?

Acanthosis nigricans develops in both males and females. It’s most common in:

Those who are overweight
People from or whose ancestors were from Africa, the Caribbean, and South or Central America, according to the American Academy of Dermatology
Native Americans
Folks with diabetes or prediabetic conditions
Those with a family history of acanthosis nigricans
Children who develop acanthosis nigricans have a higher risk of developing type 2 diabetes later in life

Clinical Presentation And Symptoms of Acanthosis Nigricans

Acanthosis nigricans manifests through several distinctive signs and symptoms, which primarily include the emergence of dark, thick, velvety skin in the folds and creases of the body. Most notably, this skin condition often makes its presence known in areas like the armpits, groin, and the back of the neck. Skin changes develop gradually, which is another notable characteristic. The impacted skin may also exhibit other symptoms, including itchiness, skin tags (small skin outgrowths), or a foul odor.

How is Acanthosis Nigricans Diagnosed?

The diagnosis of acanthosis nigricans is made following a skin examination. While it’s usually fast and simple, providers might take a skin biopsy in order to examine the skin under a microscope to confirm the diagnosis and rule out other similar skin conditions. Acanthosis nigricans is easy to recognize by sight. Your doctor may want to check for diabetes or insulin resistance as the cause. These tests may include blood glucose tests or fasting insulin tests. Your doctor may also review your medications to see if they’re a contributing factor. In rare cases, your doctor may perform other tests, like a small skin biopsy, to rule out other possible causes.

Functional Medicine Labs to Test That Can Help Individualize Treatment for Acanthosis Nigricans

Functional medicine labs offer a variety of tests that can help tailor treatment to patients, allowing providers to optimize management strategies.

Diabetes Testing: This panel is excellent for understanding your insulin and glucose levels which are major players in acanthosis nigricans.
Stool Testing: This test checks for bacterial overgrowth and parasitic infections, which could be causing gut inflammation. A calm gut could help your body better manage insulin, potentially reducing symptoms.
Hormone Testing: This test checks out key hormones that could be out of balance, such as cortisol, which is linked to insulin resistance.
Lipid Testing: This panel is a deep dive into your lipid levels. If you've got irregular lipid levels, it could affect your insulin levels, making it an excellent test to consider when dealing with acanthosis nigricans.
Hs-CRP Testing: With obesity being a risk factor for acanthosis nigricans and heart disease, this test, which measures inflammation and cardiovascular risk, is worth a look to evaluate associated decreases in heart health.

Acanthosis Nigricans Diet Treatment

As acanthosis nigricans is often related to dysregulated insulin levels and obesity, a diet that takes this into consideration is important. Eating a nutrient-dense diet focused on maintaining steady insulin levels and avoiding processed foods may help manage this condition by attending to the underlying factors. Eating a special diet can help reduce circulating insulin and may lead to some improvement of the acanthosis nigricans.

Dietary Recommendations

Aim for a large intake of vegetables, particularly dark green, leafy ones like spinach, due to their low-calorie count and high nutrient content. However, it's important to be mindful of starchy vegetables, like potatoes, peas, and corn, due to their higher carb content.
Adding a variety of fruits into your diet, as they're loaded with vitamins, minerals, and fiber. Try swapping fruits for sweets to manage cravings, and stick to fresh fruits instead of canned ones with added syrup.
High-fiber foods such as almonds, black beans, broccoli, lentils, and oatmeal are recommended because the consumption of more than 50 grams of fiber per day may aid in blood sugar balance.
Selecting lean proteins, such as skinless chicken or turkey, certain fish, low-fat cheese and egg whites, and plant-based proteins like beans, lentils, and nut butters, can help to maintain adequate protein intake while limiting fat consumption.
Lastly, healthy fats, such as olive, sunflower, and sesame oils, may help support insulin sensitivity, while low-fat dairy products can provide essential calcium and protein with fewer calories.

Lifestyle Changes

Maintaining a healthy lifestyle can usually prevent acanthosis nigricans, including:

Maintaining a moderate weight
Managing your diet
Adjusting any medications contributing to the condition

The good news is that taking control over your weight -- learning to eat well, being active and losing some weight -- lowers the amount of unused insulin in your body. Losing weight will be an important part of your care plan. Try to avoid eating fried foods like French fries, chips and chicken. Eat a lot of fruits and vegetables. The more calories you burn up, the better your body uses insulin. You don’t have to start running marathons. But make sure that you do something active every day. It can be shooting hoops, mowing the lawn, shoveling snow, walking, - anything that raises your heartbeat for 20 minutes or more. Daily physical activity for children is especially important with their transition back to school in the fall.

Supplements and Herbs For Acanthosis Nigricans Management

For patients interested in supplements and herbs, there are various options that may help support overall health.

Berberine: Berberine is frequently used for patients who wish to support healthy blood sugar levels. Additionally, it has also been shown to help patients improve their lipid profiles. Dose: 0.4-1.5 grams daily. Duration: 2 years
Green Tea Extract: A meta-analysis on the subject showed that regular caffeinated green tea (“catechin-caffeine”) increased fat loss compared to placebo. Additionally, green tea extract has shown benefits in supporting healthy lipid levels and possibly reducing heart disease risk. Dose: 400-500mg/day or approximately 8 cups of green tea. Duration: As symptoms persist
Vitamin D: Vitamin D has been shown to significantly support weight management and waist circumference. Dose: 50,000 IU per week. Duration: 6 weeks

The Importance of Physical Activity and Exercise for Patients With Acanthosis Nigricans

While regular physical activity is an important part of general health, it is especially important for those with acanthosis nigricans. As losing weight can often help manage the condition, a regular exercise regimen should play a part in management. According to the CDC, in order to lose weight and keep it off, you need to incorporate a “high” amount of physical activity. This also includes changing your diet, as discussed above, as losing weight also necessitates healthier eating. To maintain your weight goals, it's recommended to get 150 minutes of moderate-intense exercise per week.

Cosmetic Treatments For Acanthosis Nigricans

If you are concerned with the appearance of your affected skin, you may want to try cosmetic treatments available. Treatments include:skin lighteners like Retin-A, 20 percent urea, alpha hydroxy acids, and salicylic acidoral acne medicationslaser therapy. Treatments to improve skin appearance and lighten the skin area include Retin-A, 20% urea, alpha hydroxy acids, lactic acid, topical vitamin D, and prescription-strength salicylic acid. These don't work very well, though. Your dermatologist may also recommend:Laser treatment to reduce the skin's thicknessAntibiotics and antibacterial soaps to reduce the odor and itchiness Your skin may also improve once you get treatment for other conditions that cause acanthosis nigricans. For example, surgery to remove a cancerous tumor may also result in the patches fading.But your patches may not go away even after treating the conditions that cause them. Remember, some people have it even without having a related health problem.

For those seeking cosmetic solutions to acanthosis nigricans, topical retinoids are often considered. As demonstrated in numerous patients, this treatment begins to show notable improvements after just two weeks. However, continual application may be necessary to maintain these benefits over time. Another type of topical treatment, vitamin D analogs, is thought to provide relief by reducing the cosmetic effects of insulin. For individuals open to a slightly more invasive approach, chemical peels, particularly those utilizing Trichloroacetic acid (TCA), can lead to significant advancements in hyperpigmentation, skin thickening, and overall appearance. Other options include laser treatments, oral retinoids, or metformin/rosiglitazone.

Patient Education and Support

For patients and providers alike, it's important to understand that the skin hyperpigmentation associated with acanthosis nigricans may not just be a skin issue; it can indicate an underlying condition, especially in middle-aged to elderly individuals. As discussed, however, the good news is that management directed toward this condition or the underlying factors can often improve or even resolve skin changes. Awareness of risk factors and symptoms of potentially serious conditions, such as malignancies linked with acanthosis nigricans, can allow for proper monitoring and prevention. Furthermore, it's important to address the possible mental health aspect. The presence of this condition can many times lead to depression and low self-esteem. In these cases, seeing a mental health professional can provide patients with an extra level of support.

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