Sunita brought her son Raj to me as he had develpoed thick skin pigmentation around his neck and armpits. She wanted to know which specialist to consult as the pigmentation off late had become very itchy. After examination, I told her it seemed to be Acanthosis nigricans and the most likely reason would be Insulin resistance or Prediabetes. The kid was 12 years old and Sunita refused to believe me. She went to a skin specialist who confirmed my diagnosis.The boy had to change his lifestyle and lose weight to overcome the skin problem.
What is this skin problem?
Acanthosis nigricans is one of the skin conditions that can make the skin in certain areas of the body look extremely dark and texturized. It is characterized by the presence of hyperpigmented skin in the body’s natural folds such as the neck, underarms, inside the elbow, behind the knees, navel, groin, etc. At times, the skin on the forehead and the face can also be affected by it.
Acanthosis nigricans may be a sign of a more serious health problem, such as prediabetes. The most effective treatments focus on finding and resolving medical conditions at the root of the problem. These skin patches tend to disappear after successfully treating the root condition.
This is seen in about 15-20% of the Indian population with people having diabetes having a high incidence rate of above 60% of acquiring this skin disorder. Children who develop acanthosis nigricans are at a higher risk of developing type 2 diabetes later in life.
Causes:
Acanthosis nigricans skin patches occur when epidermal skin cells begin to reproduce rapidly. It is a symptom of many problems within. There are many underlying causes.
High Insulin:
Abnormal production of the hormone Insulin due to frequent triggers, develops into a condition called Insulin resistance. Although the pancreas constantly produces insulin, the body cannot use it properly. This creates a buildup of glucose in the bloodstream, which results in high levels of both blood glucose and insulin in our bloodstream.Excess insulin causes normal skin cells to reproduce at a rapid rate. For those with dark skin, these new cells have more melanin. This increase in melanin produces a patch of skin that is darker than the skin surrounding it. Thus, the presence of Acanthosis nigricans is a strong predictor of future diabetes.
Medications:
Medications like niacin, birth control pills, some bodybuilding supplements, and corticosteroids can lead to acanthosis nigricans.
Hormonal imbalance:
Acanthosis nigricans is also commonly seen in people who have an underlying issue that leads to a hormonal imbalance, such as thyroid problem, PCOS, and disorders of the adrenal glands or pituitary gland.
Cancer:
Cancer of the stomach, liver or colon can cause acanthosis nigricans patches to develop very quickly.
Diagnosis:
Precise examination of the affected parts by a qualified medical practioner is important for a confirmed diagnosis. The doctor would check for diabetes or insulin resistance as the cause. These tests may include blood glucose tests or fasting insulin tests. In rare cases a skin biopsy to rule out other possible causes is performed.
Treatment:
Depending on the underlying cause, different courses for acanthosis nigricans treatment are undertaken.
- Losing weight
- Eating healthy
- Medications to bring blood sugar under control
- Replacing medications that are triggering acanthosis
- Relevant treatment for hormonal issues
Once the underlying cause is brought under control, the dark patches formed fade away to a great extent. But, this form of treatment can take a while to show results. For instant results, cosmetic therapies can be opted for in conjunction with the medical treatment.
Conclusion:
We should take this skin pigmentation disorder seriously as in most cases it is an indication of something more serious happening within the body. It is a reminder to us that something is wrong internally and needs correction.