A case of hyperpigmentation and acanthosis nigricans by testosterone injections

Abstract

<jats:p> Drug-related skin disorders may occur in many different ways. Despite pigmentary changes being less important for morbidity, these changes precipitate depressed mood and reduce self-confidence. Testosterone is a steroid hormone from the androgen group and primarily used for the treatment of hypogonadism in males. Testosterone replacement can cause skin problems like acne, hair loss, redness, pain, or infection at the injection site. </jats:p><jats:p> The study was conducted on a 49-year-old man with adult onset idiopathic hypogonadotropic hypogonadism, which is an acquired form of isolated gonadotropin-releasing hormone deficiency. He was presented with lack of energy and decreased sexual function 10 years ago and was given an oil-based injectable blend of four esterized testosterone compounds as hormone replacement treatment in a urology polyclinic. He was referred to our polyclinic by endocrinologist because of progressive hyperpigmentation marked on his face and oral mucosa. In the present study, we report the first testosterone therapy-related facial and oral mucosal hyperpigmentation and acanthosis nigricans in the same patient. </jats:p>

Introduction of a novel quantitative scoring system for acanthosis nigricans and its validation in a pilot study

“…Even excluded from the study were subjects with a history of drug use which can cause AN (orally nicotinic acid, oral contraceptives, testosterone, triazinate, or topically fusidic acid) as well as subjects who were pregnant or breast feeding, unable to give a cohesive history, had a high alcohol intake (>14 units/week for women and >21 units/week for men), or used illicit drugs. [17][18][19] The including and excluding criteria are listed in Table 1. any one of the following criteria: HbA1c value of ≥6.5%, or fasting glucose (≥126 mg/dL), or 2-hour glucose (≥200 mg/dL), or random glucose (≥200 mg/dL) in patients with classic symptoms of DM.…”

“…Excluded were patients with a history of, being investigated for, or diagnosed with one or more of the following diseases: internal malignancies especially of gastrointestinal tract, and autoimmune diseases, such as systemic lupus erythematosus, scleroderma, Sjögren's syndrome, and Hashimoto's thyroiditis. Even excluded from the study were subjects with a history of drug use which can cause AN (orally nicotinic acid, oral contraceptives, testosterone, triazinate, or topically fusidic acid) as well as subjects who were pregnant or breast feeding, unable to give a cohesive history, had a high alcohol intake (>14 units/week for women and >21 units/week for men), or used illicit drugs 17‐19 . The including and excluding criteria are listed in Table 1.…”

Drug‐induced acanthosis nigricans: A systematic review and new classification

“…A total of 13 acanthosis nigricans-inducing drugs were identified from the systematic literature search. These drugs included nicotinic acid, [4][5][6][7][8][9][10][11][12] niacinamide, 13 insulin, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] aripiprazole, 29 oral corticosteroids, 12,30,31 somatotrophin, 32 oral contraceptives, 33 diethylstilbestrol, [34][35][36] testosterone, 37,38 pituitary extract of β-Melanocyte stimulating hormone (β-MSH), 39 triazinate, 40 amprenavir, 41 palifermin, 42,43 and fusidic acid ointment. 44 We discuss each drug in detail below and provide a summary in Table 1 15 3 months, 15 1 year, 16 3 months, 18 4 months 22…”

“…There are two reports suggesting that testosterone could be associated with development of AN. 37,38 A 43-year-old man with Klinefelter's syndrome treated with intramuscular methyltestosterone for testicular atrophy and low serum testosterone. 37 After years of treatment he presented with skin tags on his neck and axillae and pigmented axillary skin with a velvety surface.…”

“…The second case reported a man with adult-onset idiopathic hypogonadotropic hypogonadism treated with an IM oil-based injectable blend of four esterized testosterone compounds. 38 He subsequently developed progressive hyperpigmentation of his face, dorsal hands, gingival mucosa, and brown patches on his extensor surface of left leg. A skin biopsy from the leg was consistent with AN.…”