Acanthosis nigricans – a warning sign of diabetes?

Acanthosis nigricans Posted On


Have you heard about acanthosis nigricans (AN)? Let me show you Acanthosis Nigricans Pictures –

credit – Mark F. Brady; Prashanth Rawla., CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

credit – Vassia Atanassova – Spiritia, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons

acanthosis nigricans

What do you think? Do you think this is dirt?


Do you think this is an allergy?

This is neither dirt nor allergy. This is actually AN.

You must have seen some people in your family or relatives who have dark patches of their skin. It is mainly found in body folds areas like the neck, underarms, groins, elbow, knees, sometimes in fingers and forehead.

Suppose you are one among them who is struggling with this skin condition. Keep reading this post because this article will be going helpful and informative.

In this post, you will know –

  •      Causes of acanthosis nigricans
  •      Insulin resistance acanthosis nigricans
  •      Treatment for acanthosis nigricans   
  •      Best cream for acanthosis nigricans   


So, let us know about this skin disorder in detail.


What is Acanthosis Nigricans (AN)?

AN is a hyperpigmented skin problem that begins with the grey-black area, which gradually becomes black warty skin.

It is usually associated with insulin intolerance diseases such as diabetes mellitus.

It can also signify other medical conditions like obesity, cancerhypothyroidismpolycystic ovary syndrome, and drug-induced acanthosis nigricans.

You will notice many dark creases with thick velvety-textured body fold areas, especially around the neck, axilla (underarm), and groin areas.

Although it is neither harmful nor contagious. But its appearance seems not good. You can feel embarrassed about the way your skin looks. 

It is more common in people of African-American and dark-skinned populations. 

It occurs in two forms – benign and malignant form. Benign acanthosis is more common than malignant.

It is usually asymptomatic, rarely pruritic. It can happen at any age but is more common after 40 years.


What are the causes of acanthosis nigricans? Does acanthosis nigricans mean I have diabetes?

You know that prevalence of obesity and diabetes is increasing day by day. Due to this, AN is strongly influenced by obesity and diabetes.

Recently, it has been observed that the rising cases of obesity and diabetes are the primary cause of the high prevalence of AN, as per Indian dermatology online journal. 

According to this study, this skin problem varies widely 7 to 74%, depending upon age, race, degree of obesity, frequency of type, and comorbid conditions. 

Acanthosis nigricans

Obesity and diabetes are the most common cause of acanthosis nigricans

These risk factors are usually associated with insulin resistance. Too much insulin in your blood can lead to AN. This type of AN is called insulin resistance acanthosis nigricans (or obesity-associated acanthosis nigricans).

AN can be a signal that indicates you are at risk of diabetes or prediabetes condition. The burden of this disease increases with a sedentary lifestyle.

A study published in the Archives of dermatology, 1992 observed acanthosis nigricans people were recorded in 74% of the obese patient.

Another study published in the journal of endocrine practice 2004 determined the prevalence of acanthosis nigricans in newly diagnosed diabetes patients.

So, obesity and diabetes are two crucial risk factors for the development of AN.

AN may also occur – 

  • If you have a problem with a hormonal condition like Cushing syndromeacromegaly, hypothyroidism, and PCOS (Polycystic Ovary Syndrome).
  • If you are taking medicines such as steroids (like prednisolone), oral contraceptives pill (birth control pills), and niacin (nicotinic acid).
  • If you are struggling with cancer, especially liver, colon, and stomach cancer.
  • If you are having this problem from birth (hereditary reason).


How does acanthosis nigricans occur?

Pathophysiology of acanthosis nigricans 

As we discussed above, insulin resistance is the primary culprit for the development of this disease.

It means your body is making extra insulin, but your muscles ignore this insulin. As a result, your body increases glucose and insulin level.

Let us understand how insulin resistance cause acanthosis nigricans –

Normally, when you eat healthy food (glucose), your pancreas releases insulin hormone slowly. The major function of insulin is to uptake glucose into the body cells.

This is happened by lock and key mechanisms. For example, insulin and glucose act as a key that binds their own receptor (lock). 

But when you take high glycemic foods (high carb food or high-calorie food), your pancreas needs to release more insulin instantly. 

The high amount of insulin may desensitize the insulin receptors. Over time, your insulin receptor goes in downregulated (less insulin receptor), leading to increased insulin and glucose levels in the blood.

This hyperinsulinemia (high insulin level) crosses the dermal-epidermal junction, which directly binds to the IGF-1 receptor (Insulin-like growth factor).

After some time, insulin propagates to outer skin cells (keratinocytes), which appear in dark skin folds and thick, velvety skin texture.

In simply, if the extra amount of insulin builds up in the keratinocytes skin layer, that causes dark skin patches. It is also called insulin resistance acanthosis nigricans 


Is acanthosis nigricans curable?

Unfortunately, it is not curable. But the good news is that it may lighten over time by treating the causes of acanthosis nigricans.   

If you have this skin disorder. Firstly, you need to check your blood test.

  • Blood glucose level
  • Insulin level
  • Cholesterol level
  • TSH, T3, and T4 level
  • HBA1C level
  • Cortisol level

These are some clinical marker that helps to evaluate the AN. There are two treatment options available – non-medication and medication.

Non-medication options 

You will have to convert your sedentary lifestyle into a healthy lifestyle. You need to focus on three primary things to control acanthosis nigricans

  1. Weight loss– BMI (Body Mass Index) should not be above 25.
  2. Diet management– You must follow a healthy diet that contains a high amount of antioxidant, vitamin E, Vitamin C, and low glycemic index food or use the ketogenic diet.
  3. Regular exercise– You may do walking, running, yoga, meditation, and gym.

Acanthosis nigricans

Once you reduce your weight and diabetes condition, you will notice the darkening of the skin does lighten over time.

Although these steps are enough to significantly reduce your AN condition, if it is not working, you may take the help of medicines.


Medicine for acanthosis nigricans   

You must consult with your dermatologist before taking medicines to treat this condition. There are two options available to treat AN superficially and internally – 

Topical treatment (Cream for acanthosis nigricans)

You may use some topical agent to reduce superficially darkening of the skin.

1. Topical retinoids– It is considered a first-line treatment that helps to reduce the AN condition. Few examples are – Tretinoin 0.1% gel/cream, combination (Tretinoin 0.05% + hydroxyquinone 4% + fluocinolone acetonide 0.01%).

Acanthosis nigricans

2. Topical vitamin D analogues– Calcipotriol 0.005% (twice daily period of 3 months). It helps to inhibit keratinocyte proliferation. According to a study, it is considered safe, effective, and well-tolerated.

Acanthosis nigricans

3. Superficial chemical peels– TCA (Trichloroacetic acid) is a chemical that eliminates the old cell and helps in the renewal of the skin.


Oral treatment

1. Oral retinoids– Oral retinoids (isotretinoin and acitretin) can be an effective option for AN. A study suggests that isotretinoin (3mg/kg/day) is effective in obesity-associated acanthosis nigricans. Acitretin is also an effective option reported in the literature.

Acanthosis nigricans

2. Metformin and rosiglitazone– These drugs are effective in insulin resistance in acanthosis nigricans. 

Acanthosis nigricans

3. Metformin with thiazolidiones – These drugs help to increase insulin sensitivity in peripheral muscles and decrease insulin levels in the blood.



Acanthosis nigricans is not a disease. It is a common skin problem and a strong warning sign of diabetes. The appearance of AN can be improved by treating the underlying problem.

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