Acanthosis nigricans |
Classification and external resources |
Acanthosis nigricans on axilla
|
ICD-10 |
L83 |
ICD-9 |
701.2 |
OMIM |
100600 |
DiseasesDB |
58 |
MedlinePlus |
000852 |
eMedicine |
derm/1 |
MeSH |
D000052 |
Acanthosis nigricans is a brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds,[1] such as the posterior and lateral folds of the neck, the armpits, groin, navel, forehead, and other areas.
Contents
- 1 Classification
- 2 Signs and symptoms
- 3 Causes
- 3.1 Endocrine
- 3.2 Obesity-related
- 3.3 Drug-related
- 3.4 Familial
- 3.5 Acral Acanthotic Anomaly
- 3.6 Malignant
- 4 Pathophysiology
- 5 Diagnosis
- 5.1 Differential Diagnosis
- 6 Prognosis
- 7 Treatment
- 8 History
- 9 References
- 10 External links
Classification
Acanthosis nigricans is conventionally divided into benign and malignant forms.,[2][3] although may be divided into syndromes according to cause.[4]:506:
- Benign This may include obesity-related, hereditary, and endocrine forms of acanthosis nigricans.[2]
- Malignant. This may include forms that are associated with tumour products and insulin-like activity, or tumour necrosis factor.[2]
An alternate classification system still used to describe acanthosis nigricans was proposed in 1994 by dermatologist Schwartz. This classification system delineates acanthosis nigricans syndromes according to their associated syndromes, including benign and malignant forms, forms associated with obesity and drugs, acral acanthosis nigricans, unilateral acanthosis nigricans, and mixed and syndromic forms.[5][6]
Signs and symptoms
Acanthosis nigricans may present with thickened, relatively darker areas of skin on the neck, armpit and in skin folds.[2]
Causes
It typically occurs in individuals younger than age 40, may be genetically inherited, and is associated with obesity or endocrinopathies, such as hypothyroidism, acromegaly, polycystic ovary disease, insulin-resistant diabetes, or Cushing's disease.
Endocrine
Endocrine syndromes associated with acanthosis nigricans can develop in many conditions, particularly:[2]:978 [7]:86
- states with insulin resistance, such as diabetes mellitus
- excess circulating androgens, particularly Cushing's disease, acromegaly, polycystic ovarian disease
- Addison's disease and hypothyroidism
- Rare diseases, including pinealoma, leprechaunism, lipotrophic diabetes, pineal hyperplasia syndrome, pituitary basophilism, ovarian hyperthecosis, stromal luteoma, ovarian dermoid cysts, Prader-Willi syndrome, and Alstrom syndrome.
Acanthosis nigricans associated with endocrine dysfunction is more insidious in its onset, is less widespread, and the patients are often concurrently obese.[8]:676 This is also known as "Acanthosis nigricans type III",[4]:506–7 and insulin resistance syndromes may be divided into Type A (HAIR-AN) and type B syndromes.[2]:978
Obesity-related
The majority of cases of acanthosis nigricans are associated with obesity and otherwise idiopathic. This is likely because of insulin resistance, and more likely to occur in darker-skinned persons.[2]:968 This is also known as "Pseudo-Acanthosis Nigricans", or "Type 3 Acanthosis Nigricans".[7]:86
Drug-related
Acanthosis nigricans has been linked to the use of nicotinic acid,[2] glucocorticoid use, COCP, growth hormone therapy, and stilbesterol.<.[7] This is also known as Type 4 Acanthosis nigricans.[7]:86
Familial
Familial acanthosis may arise as a result of an autosomal dominant trait, presenting at birth or developing during childhood.[4]:506[8]:676. This is also known as Acanthosis nigricans type 1.[7]:86
Acral Acanthotic Anomaly
Acral Acanthotic Anomaly refers to a variant of acanthosis nigricans limited to the elbows, knees, knuckles and dorsal surfaces of the feet, in the absence of any other findings, in otherwise healthy individuals.[9][10][11][12] While the etiology remains unknown,[12] its presence does not suggest a likelihood of malignancy.[12]
Malignant
Malignant acanthosis nigricans refers to acanthosis nigricans occurring as a paraneoplastic syndrome associated with a cancer. Malignant acanthosis nigricans is most-commonly associated with gastrointestinal adenocarcinomas, as well as genitourinary cancers such as those of the prostate, breast, and ovary. Other cancers, such as those of the lung, stomach, and lymphoma, are occasionally associated with acanthosis nigricans.[7]:86[13]
This form of acanthosis nigricans is more likely to involve mucous membranes (25-50% of cases)[3][14] This variant is also known as Acanthosis nigricans type I[8]:676 or 5[7]:86. Malignant acanthosis nigricans that may either precede (18%), accompany (60%), or follow (22%) the onset of an internal cancer.[4]:506 Malignancy-associated acanthosis nigricans is usually rapid in onset and may be accompanied by skin tags, multiple seborrheic keratoses, or tripe palms.[8]:676
Pathophysiology
The pathogenesis of acanthosis nigricans is poorly understood, and likely to relate to an interplay of factors,[15] including insulin-mediated activation of ILGF receptors on keratinocytes, and increased growth factor levels.[15]
Factors involved in the development of acanthosis nigricans include:
- Increased circulating insulin. This activates keratinocyte ILGF receptors, particularly IGF-1. At high concentrations, insulin may also displace IGF-1 from IGFBP. Increased circulating IGF may lead to keratinocyte and dermal fibroblast proliferation.[15]
- Fibroblast growth factor. Hereditary variants are associated with FGFR defects.[15]
- Increased TGF, which appears to be the mechanism for malignancy-associated acanthosis nigricans. TGF acts on epidermal tissue via the EGFR.[7]:86
In conjunction with increased end levels of ILGF, it is likely that perspiration and friction may be necessary predeterminants for lesions.[15]
Diagnosis
Acanthosis nigricans is typically diagnosed clinically.[2] A skin biopsy may be needed in unusual cases. If no clear cause of acanthosis nigricans is obvious, it may be necessary to search for one. Blood tests, an endoscopy, or x-rays may be required to eliminate the possibility of diabetes or cancer as the cause.[7]:87
On biopsy, hyperkaratosis, epidermal folding, leukocyte infltration, and melanocyte proliferation may be seen.[2]:979[7]:87
Differential Diagnosis
Acanthosis nigricans should be distinguished from the Casal collar appearing in pellegra.[citation needed]
Prognosis
Acanthosis nigricans is likely to improve in circumstances where a known cause is removed. For example, obesity-related acanthosis nigricans will improve with weight loss, and drug-induced acanthosis nigricans is likely to resolve when the drug is ceased. Hereditary variants may or may not fade with age, and malignancy-associated variants may, after a malignancy is removed, fade.[7] :87
Treatment
People with acanthosis nigricans should be screened for diabetes and, although rare, cancer. Controlling blood glucose levels through exercise and diet often improves symptoms. Topical fade creams (normally used for eliminating age spots) can lighten skin cosmetically in less severe cases. Acanthosis nigricans maligna may resolve if the causative tumor is successfully removed.[16]
History
|
This section requires expansion. (August 2013) |
References
- ^ "acanthosis nigricans" at Dorland's Medical Dictionary
- ^ a b c d e f g h i j Habif, Thomas P. (2009). Clinical dermatology (5th ed.). Edinburgh: Mosby. ISBN 978-0-7234-3541-9.
- ^ a b Ngan, Vanessa. "Acanthosis nigricans". Retrieved 23 August 2013.
- ^ a b c d James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
- ^ Garofalo, L.; A.M. Biscozzi; V. Mastrandrea; E. Bonifazi (2003). "Acanthosis nigricans vulgaris. A marker of hyperinsulinemia.". Eur. J. Pediat. Dermatol. 13: 85–8. Retrieved 2010-07-29.
- ^ Schwartz, Robert A. (1994). "Acanthosis nigricans". Journal of the American Academy of dermatology 31 (1): 1–19. doi:10.1016/S0190-9622(94)70128-8. PMID 8021347.
- ^ a b c d e f g h i j k and others (2005). Fitzpatrick's color atlas and synopsis of clinical dermatology (5th ed.). New York: McGraw-Hill Medical Pub. Division. ISBN 0-07-144019-4.
- ^ a b c d Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
- ^ Schwartz RA (February 2007). "Acral acanthosis nigricans (acral acanthotic anomaly)". J. Am. Acad. Dermatol. 56 (2): 349–50. doi:10.1016/j.jaad.2006.09.027. PMID 17224380.
- ^ Schwartz RA (September 1981). "Acral acanthotic anomaly (AAA)". J. Am. Acad. Dermatol. 5 (3): 345–6. doi:10.1016/S0190-9622(81)80155-7. PMID 7263979.
- ^ Schwartz RA (July 1994). "Acanthosis nigricans". J. Am. Acad. Dermatol. 31 (1): 1–19; quiz 20–2. doi:10.1016/S0190-9622(94)70128-8. PMID 8021347.
- ^ a b c Tilgen W (2009). "Benign epidermal tumors". In WHC Burgdorf, G Plewig, HH Wolff, M Landthaler, O Braun-Falco. Braun-Falco's Dermatology (3rd ed.). Heidelberg: Springer. pp. 1340–7. ISBN 3-540-29312-4.
- ^ Rigel DS, Jacobs MI; Jacobs (1980). "Malignant acanthosis nigricans:a review". J Dermatol Surg Oncol 6 (11): 923 . PMID 6257767.
- ^ Schnopp C, Baumstark J; Baumstark (2007). "Oral acanthosis nigricans". N Engl J Med 357 (9): e10. doi:10.1056/NEJMicm062917. PMID 17761587.
- ^ a b c d e Higgins, SP; Freemark, M; Prose, NS (Sep 15, 2008). "Acanthosis nigricans: a practical approach to evaluation and management.". Dermatology online journal 14 (9): 2. PMID 19061584.
- ^ Brown J, Winkelmann RK; Winkelmann (1968). "Acanthosis nigricans: study of 90 cases". Medicine 47 (1): 33 . doi:10.1097/00005792-196801000-00002. PMID 4868603.
External links
|
Wikimedia Commons has media related to Acanthosis nigricans. |
- AOCD
- http://www.skinsight.com/adult/acanthosisNigricans-references.htm
- 00001 at CHORUS
Pigmentation disorders/Dyschromia (L80–L81, 709.0)
|
|
Hypo-/
leucism |
Loss of melanocytes |
vitiligo: |
- Quadrichrome vitiligo
- Vitiligo ponctué
|
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syndromic |
- Alezzandrini syndrome
- Vogt–Koyanagi–Harada syndrome
|
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melanocyte development: |
- Piebaldism
- Waardenburg syndrome
- Tietz syndrome
|
|
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Loss of melanin/
amelanism |
albinism: |
- Oculocutaneous albinism
- Ocular albinism
|
|
melanosome transfer: |
- Hermansky–Pudlak syndrome
- Chédiak–Higashi syndrome
- Griscelli syndrome
- Elejalde syndrome
- Griscelli syndrome type 2
- Griscelli syndrome type 3
|
|
other: |
- Cross syndrome
- ABCD syndrome
- Albinism–deafness syndrome
- Idiopathic guttate hypomelanosis
- Phylloid hypomelanosis
- Progressive macular hypomelanosis
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|
|
Leukoderma w/o
hypomelanosis |
- Vasospastic macule
- Woronoff's ring
- Nevus anemicus
|
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Ungrouped |
- Nevus depigmentosus
- Postinflammatory hypopigmentation
- Pityriasis alba
- Vagabond's leukomelanoderma
- Yemenite deaf-blind hypopigmentation syndrome
- Wende–Bauckus syndrome
|
|
|
Hyper- |
Melanin/
Melanosis/
Melanism |
Reticulated |
- Dermatopathia pigmentosa reticularis
- Pigmentatio reticularis faciei et colli
- Reticulate acropigmentation of Kitamura
- Reticular pigmented anomaly of the flexures
- Naegeli–Franceschetti–Jadassohn syndrome
- Dyskeratosis congenita
- X-linked reticulate pigmentary disorder
- Galli–Galli disease
- Revesz syndrome
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|
Diffuse/
circumscribed |
- Lentigo/Lentiginosis: Lentigo simplex
- Liver spot
- Centrofacial lentiginosis
- Generalized lentiginosis
- Inherited patterned lentiginosis in black persons
- Ink spot lentigo
- Lentigo maligna
- Mucosal lentigines
- Partial unilateral lentiginosis
- PUVA lentigines
- Melasma
- Erythema dyschromicum perstans
- Lichen planus pigmentosus
- Café au lait spot
- Poikiloderma (Poikiloderma of Civatte
- Poikiloderma vasculare atrophicans)
- Riehl melanosis
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Linear |
- Incontinentia pigmenti
- Scratch dermatitis
- Shiitake mushroom dermatitis
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Other/ungrouped |
- Acanthosis nigricans
- Freckle
- Familial progressive hyperpigmentation
- Pallister–Killian syndrome
- Periorbital hyperpigmentation
- Photoleukomelanodermatitis of Kobori
- Postinflammatory hyperpigmentation
- Transient neonatal pustular melanosis
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|
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Other
pigments |
iron: |
- Hemochromatosis
- Iron metallic discoloration
- Pigmented purpuric dermatosis
- Schamberg disease
- Majocchi's disease
- Gougerot–Blum syndrome
- Doucas and Kapetanakis pigmented purpura/Eczematid-like purpura of Doucas and Kapetanakis
- Lichen aureus
- Angioma serpiginosum
- Hemosiderin hyperpigmentation
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other metals: |
- Argyria
- Chrysiasis
- Arsenic poisoning
- Lead poisoning
- Titanium metallic discoloration
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other: |
- Carotenosis
- Tattoo
- Tar melanosis
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Dyschromatoses |
- Dyschromatosis symmetrica hereditaria
- Dyschromatosis universalis hereditaria
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|
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noco (i/b/d/q/u/r/p/m/k/v/f)/cong/tumr (n/e/d), sysi/epon
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proc, drug (D2/3/4/5/8/11)
|
|
|
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Cutaneous keratosis, ulcer, atrophy, and necrobiosis (L82–L94, 700–701.5)
|
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Epidermal thickening |
- keratoderma: Keratoderma climactericum
- Paraneoplastic keratoderma
- Acrokeratosis paraneoplastica of Bazex
- Aquagenic keratoderma
- Drug-induced keratoderma
- Paraneoplastic keratoderma
- psoriasis
- Keratoderma blennorrhagicum
- keratosis: Seborrheic keratosis
- Clonal seborrheic keratosis
- Common seborrheic keratosis
- Irritated seborrheic keratosis
- Seborrheic keratosis with squamous atypia
- Reticulated seborrheic keratosis
- Dermatosis papulosa nigra
- Keratosis punctata of the palmar creases
- other hyperkeratosis: Acanthosis nigricans
- Confluent and reticulated papillomatosis
- Callus
- Ichthyosis acquisita
- Arsenical keratosis
- Chronic scar keratosis
- Hyperkeratosis lenticularis perstans
- Hydrocarbon keratosis
- Hyperkeratosis of the nipple and areola
- Inverted follicular keratosis
- Lichenoid keratosis
- Multiple minute digitate hyperkeratosis
- PUVA keratosis
- Reactional keratosis
- Stucco keratosis
- Thermal keratosis
- Viral keratosis
- Warty dyskeratoma
- Waxy keratosis of childhood
- other hypertrophy: Keloid
- Hypertrophic scar
- Cutis verticis gyrata
|
|
Necrobiosis/granuloma |
Necrobiotic/palisading |
- Granuloma annulare
- Perforating
- Generalized
- Subcutaneous
- Granuloma annulare in HIV disease
- Localized granuloma annulare
- Patch-type granuloma annulare
- Necrobiosis lipoidica
- Annular elastolytic giant cell granuloma
- Granuloma multiforme
- Necrobiotic xanthogranuloma
- Palisaded neutrophilic and granulomatous dermatitis
- Rheumatoid nodulosis
- Interstitial granulomatous dermatitis/Interstitial granulomatous drug reaction
|
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Foreign body granuloma |
- Beryllium granuloma
- Mercury granuloma
- Silica granuloma
- Silicone granuloma
- Zirconium granuloma
- Soot tattoo
- Tattoo
- Carbon stain
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Other/ungrouped |
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|
|
Dermis/
localized CTD |
Cutaneous lupus
erythematosus |
- chronic: Discoid
- Panniculitis
- ungrouped: Chilblain
- Lupus erythematosus–lichen planus overlap syndrome
- Tumid
- Verrucous
- Rowell's syndrome
|
|
Scleroderma/
Morphea |
- Localized scleroderma
- Localized morphea
- Morphea–lichen sclerosus et atrophicus overlap
- Generalized morphea
- Atrophoderma of Pasini and Pierini
- Pansclerotic morphea
- Morphea profunda
- Linear scleroderma
|
|
Atrophic/
atrophoderma |
- Lichen sclerosus
- Anetoderma
- Schweninger–Buzzi anetoderma
- Jadassohn–Pellizzari anetoderma
- Atrophoderma of Pasini and Pierini
- Acrodermatitis chronica atrophicans
- Semicircular lipoatrophy
- Follicular atrophoderma
- Linear atrophoderma of Moulin
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Perforating |
- Kyrle disease
- Reactive perforating collagenosis
- Elastosis perforans serpiginosa
- Perforating folliculitis
- Acquired perforating dermatosis
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Skin ulcer |
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Other |
- Calcinosis cutis
- Sclerodactyly
- Poikiloderma vasculare atrophicans
- Ainhum/Pseudo-ainhum
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noco (i/b/d/q/u/r/p/m/k/v/f)/cong/tumr (n/e/d), sysi/epon
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proc, drug (D2/3/4/5/8/11)
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Paraneoplastic syndromes
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Endocrine |
- Hypercalcaemia
- SIADH
- Zollinger–Ellison syndrome
- Cushing's syndrome
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Hematological |
- Granulocytosis
- Multicentric reticulohistiocytosis
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Neurological |
- Paraneoplastic cerebellar degeneration
- Encephalomyelitis
- Limbic encephalitis
- Opsoclonus
- Polymyositis
- Transverse myelitis
- Lambert–Eaton myasthenic syndrome
- Anti-NMDA receptor encephalitis
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Musculoskeletal |
- Dermatomyositis
- Hypertrophic osteopathy
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Mucocutaneous |
reactive erythema: |
- Erythema gyratum repens
- Necrolytic migratory erythema
|
|
papulosquamous: |
- Acanthosis nigricans
- Ichthyosis acquisita
- Acrokeratosis paraneoplastica of Bazex
- Extramammary Paget's disease
- Florid cutaneous papillomatosis
- Leser-Trélat sign
- Pityriasis rotunda
- Tripe palms
|
|
other/ungrouped: |
- Febrile neutrophilic dermatosis
- Pyoderma gangrenosum
- Paraneoplastic pemphigus
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