Therapeutic implications of dermoscopic findings in acanthosis nigricans: A clinical and histopathological study

Abstract

Acanthosis nigricans is associated with numerous systemic disorders. These include endocrinological conditions such as, diabetes, acromegaly, Cushing's syndrome, thyroid dysfunction, as well as metabolic abnormalities like obesity and polycystic ovarian disease. Its association with visceral malignancy is known. Moreover, Acanthosis nigricans is known to be a cutaneous marker of insulin resistance (IR) and hyperinsulinemia. The primary aim of this study was to study clinical and histopathological patterns of acanthosis nigricans and its correlation with dermoscopic patterns and treatment implications. 103 patients clinically diagnosed as acanthosis nigricans were enrolled in the study. Clinical evaluation, dermoscopy, and skin biopsy was done for histopathological evaluation. Consistency was observed in the changes seen on dermoscopy with clinical and histopathological findings. Common dermoscopy findings were Crista Cutis, Sulcus Cutis, Papillary projections, hyperpigmented dots, crypts, and blotching Dermoscopic findings can be correlated with histopathological features. Dermoscopy allows visualization on higher magnification which helps to pick up subtle changes which are not visible to naked eye. Dermoscopy can be a useful tool to distinguish acanthosis nigricans from other pigmentary disorders in patients who are not willing for histopathological examination and helps in treatment making decisions.

Skin anomalies in acromegalic patients (Review of the practical aspects)

“…Endocrine-related conditions associated with acanthosis nigricans include DM, acromegaly, polycystic ovary syndrome, Cushing syndrome, and obesity with insulin resistance (the skin lesion is the hallmark of insulin resistance) (42). Dermoscopic and skin biopsy might bring supplementary information (43). Androgen excess may also cause it, also inducing hirsutism (hirsutism has been reported in acromegaly and prolactinoma, too, as well as acne) (44).…”

Acanthosis Nigricans: Pointer of Endocrine Entities

“…AN has hyperpigmentation of a brown, dark blue, or black color, with a velvet-like texture, and typically involves areas such as the neck, axilla, and knuckles (top three most frequent sites), as well as the groin, umbilical, and perianal regions. AN has also been found in the inframammary area, as well as the antecubital and popliteal fossae, with a symmetrical pattern of distribution [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. The same patient may display different patterns at distinct locations, or due to skin changes, in a time-dependent manner.…”

“…(a severity score between 0 and 46) of the disease [ 43 ]. On the other hand, texture grading of AN may correlate with the severity of metabolic complications, and simple identification of AN may serve as a non-invasive tool for IR screening, especially in populations who are assessed or followed for different purposes such as pediatric cohorts during scholar evaluation programs [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ].…”

“…By having a typical (clinical) appearance, diagnosis of AN is straightforward; however, a dermoscopic examination may be required in some cases, such as cases with sulcus cutis, hyperpigmented spots, crista cutis, or papillary projections. A skin biopsy may be necessary to provide a pathological report that typically identifies epidermal hyperkeratosis, papillomatosis, and acanthosis elements [ 29 , 35 , 38 ]. Histological examination helps with differential diagnosis for similar lesions such as confluent and reticulated papillomatosis, as well as in obese children and teenagers and women with PCOS with associated AN [ 44 , 45 ].…”

“…Histological examination helps with differential diagnosis for similar lesions such as confluent and reticulated papillomatosis, as well as in obese children and teenagers and women with PCOS with associated AN [ 44 , 45 ]. Overall, most dermoscopic findings correlate with pathological reports, allowing a useful magnification to differentiate AN from other hyperpigmentation; thus, skin biopsies are not typically required [ 35 , 46 , 47 ].…”