VELVETY NECK/ ACANTHOSIS NIGRICANS

Velvety Neck/ Velvety Skin Folds/ Acanthosis Nigricans

• Acanthosis nigricans (AN) is characterized by hyper-pigmented verrucous or velvety plaques that usually appear on flexural surfaces and in intertriginous regions.
• It is most commonly seen in individuals with insulin resistance sates especially obesity and less frequently with other metabolic diseases, genetic syndromes, drugs, and malignancy.

MANAGEMENT STRATEGY

• The management of patients with acanthosis nigricans addresses the underlying cause, the identification of patient’s history, a targeted physical examination, focused diagnostic laboratory tests, and occasionally radiologic evaluation
• Relevant historical information includes age at onset, presence or absence of a family history, medication, transplant history, and presence or absence of symptoms related to hyperinsulinemia (with or without virilism), hypercortisolism and internal malignancy (with or without weight loss).
• Acanthosis nigricans has also been associated with renal and lung transplantation.
• Physical examination should document obesity, masculinization, lymphadenopathy, cushingoid features, and organomegaly.
• Initial laboratory screening should include fasting blood glucose and serum insulin tested concurrently to confirm or exclude insulin resistance.
• Specific investigations
• Document obesity based on ideal body weight, height, body mass index (BMI)
• Consider fasting blood glucose and insulin levels in parallel.
• Also consider ordering HbA1c, alanine aminotransferase (ALT), and fasting lipoprotein profile in obese patients.
• Depending on historical clues, screen for other endocrine diseases.
• In case of malignancy refer to appropriate specialist for the best diagnostic procedure.
• Consider drugs as a cause.
• Consider familial/genetic disorders as a cause.

TREATMENTS:

Treat the underlying cause - correction of hyperinsulinemia, weight reduction in obesity associated AN

• Keratolytics
• Oral agents like retinoids, dietary oils
• Microdermabrasion and fractional lasers are helpful in reduction of acanthosis nigricans

PREVENTION: Weight management