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.

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