Acanthosis nigricans; at a glance
- Best Results4-20 weeks
- Treatment Recovery0 days
- Procedure Time2 minutes
- Skin SpecialistDermatologist
- Duration of ResultsVariable
- AnaestheticNil required
- Back to WorkNA
Acanthosis nigricans present as dark patches involving the underarms, back of the neck & groin areas. Extensively it can present as pigmentation of the face. This condition requires a multidisciplinary approach, including skin care, lasers, lifestyle & dietary modifications.
Key PointsAcanthosis nigricans treatment
- Acanthosis nigricans is a common cause of skin hyperpigmentation, especially of the underarms & neck area
- The best treatment is a combined approach of skin directed treatments & metabolic modifications
- A simple skin care routine is a BHA wash & retinol (read more to understand)
- Pico, pigment & fractional lasers can be effective in some cases
- The biggest traction is with dietary & lifestyle modifications
- Metformin & Ozempic are promising adjuncts to reducing hyperpigmentation
What is the best treatment for acanthosis nigricans?
A combination of skin care, lasers, lifestyle choices & where indicated, tablets to help with metabolism provides the highest chance of success. Reduction of dark skin often takes many months to achieve the desired results.
What lasers do we use to treat acanthosis nigricans?
At Cutis Dermatology Brisbane we use both pico lasers & Spectra lasers, whilst in Sydney my team uses pigment & fractional laser resurfacing to treat AN. Pico lasers offer advantages over older Q switch & fractional lasers.
How often is laser treatment performed & how soon do I see the results?
Pico, pigment & fractional lasers are performed every 4 to 8 weeks. A series of 4-6 sessions is required over 4 to 8 months. Results can be seen after the first treatment, however a realistic goal is an improvement of between 20 to 60% over half a year.
Ideally lasers should be used as adjunctive therapy. Weight loss, diabetes management, & close monitoring of blood sugars form the cornerstone of management. Note- results from lasers are variable.
What is involved with laser treatment & is it painful?
The lasers we use are painless & are the most effective for skin pigmentation. Most cases only require skin cooling, without the need for numbing creams. Each laser session takes between 2 to 6 minutes to complete, & is not associated with any downtime.
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Can creams make a difference?
Creams can make a marginal difference in most cases of acanthosis. Much like lasers, creams should be used as adjunctive treatment to weight loss & blood sugar monitoring. Our dermatologists employ the following topicals-
- Retinol for most cases
- Retinoid creams such as tretinoin for resistant cases
- AHAs such as glycolic & lactic acids
- Salicylic acid washes
More on how to use skin care below.
Why is maintaining a healthy body weight the key to management?
One of the underlying causes of AN is obesity or a higher than average BMI. Weight loss can help resolve the issue of AN, improving pigmentation & dark patches. Our dermatologists will liaise with your treating GP to help you with your weight loss journey.
Can chemical peels help?
Yes, but in darker skin types it can be complicated. I prefer lasers as they are safer. Peels can be performed, & they include:
- Salicylic acid stat peel 15 to 30%.
- Lactic acid peel
- Glycolic acid peel, step up 20 to 50%, early neutralization
- TCA at 10 to 15 % 1-3 coats with or without Jessner Peel
- Retinoic acid peels at 2-7%
Of these peeling agents, retinoic acid or salicylic acid peels are safest as acanthosis nigricans frequently affect darker skin types.
Can all cases of acanthosis nigricans be treated?
No. AN is a medical condition. This means there are cases that respond well to treatment, & others that do not. Skin care, weight loss, glucose management & lasers provide the highest chances of clearing up unwanted skin pigmentation.
Disclaimer: results from lasers are variable.
Can tablets help treat acanthosis nigricans?
Two tablets have been shown to be of benefit in treating AN.
- Metformin: this can improve glucose tolerance & modulate IGF-1 levels, in turn reducing discolouration.
- Retinoids: vitamin A orally can help, but side effects are universally encountered.
*Metformin can be prescribed by your GP. Retinol & retinoid creams are far safer than tablets.
What is a simple skin care routine that can help reduce the hyperpigmentation of AN?
This simple & cost effective skin care routine can help reduce pigmentation in some cases of acanthosis nigricans is-
- Skin care acids, BHA wash 1.5 to 2% salicylic acid. Wash in the shower daily, increase to twice a day as tolerated.
- Retinol 0.1 to 0.3%, apply nightly, increase as tolerated.
*Skin care is adjunct to lasers, dietary & lifestyle changes.
Why do skin tags occur with this condition?
Skin tags are frequently seen with AN due to their association with PCOS & weight gain. Tags can be treated by your GP or at a skin cancer clinic.
*Our dermatologists & nurses do not perform skin tag removal. You can DIY via YouTube videos, or seek advice from an experienced esthetician. A simple way to remove skin tags is with a nail clipper.
How can a dietician help & can foods play a role?
Do not underestimate the value of a dietician in the management of AN. They are integral to keeping your weight down, in addition to carefully selecting food to help you maintain a consistent blood sugar level.
How can an endocrinologist help with treatment?
If you have more complex issues such as PCOS, glucose intolerance or other endocrine issues, your GP may involve the help of an endocrinologist.
AN is complicated, & often requires a team of healthcare professionals to effectively manage this condition. My team & I, as skin specialist, only deal with skin issues, namely pigmentation. Treating the underlying factors are equally, if not more important.
What is the relationship between AN & PCOS?
It is complex. Both conditions can occur together as PCOS presents as a constellation of skin signs such as acne, skin pigmentation, skin tags, oily skin, excessive hair & conversely female pattern hair loss.
When to see a dermatologist?
Dermatologists at Cutis Brisbane can diagnose and treat acanthosis nigricans with topical creams & lasers. They will encourage you to see your primary care physician for management of other factors that may be associated with AN, for example weight management & or glucose tolerance testing.
What are emerging treatments for acanthosis nigricans?
I suspect the drug called Ozempic or semaglutide will make a huge difference in the management of acanthosis nigricans. Though unfounded as of late 2023, by logic, it should reduce weight & improve glucose tolerance, possibly even better than metformin (established as treatment for acanthosis nigricans).
Ozempic is a prescription medication used to improve blood sugar control in adults with type 2 diabetes. It’s important to consult with a healthcare professional before starting Ozempic. They will provide specific instructions based on your individual needs and medical history. Here are some general guidelines on how to start Ozempic:
- Schedule an appointment with your doctor or diabetes specialist to discuss your diabetes management and the possibility of starting Ozempic. They will assess your condition, review your medical history, and determine if Ozempic is appropriate for you.
- Obtain a prescription: If your healthcare provider determines that Ozempic is suitable for you, they will write a prescription for the medication. Ensure you understand the dosage and any specific instructions they provide.
- Familiarize yourself with the medication: Read the patient information leaflet provided with the medication carefully. It contains important information about the drug, its proper use, potential side effects, and precautions.
- Prepare the medication: Ozempic comes in a pre-filled pen for subcutaneous (under the skin) injection. Follow the instructions provided in the package insert or consult with your healthcare provider for proper preparation and administration techniques.
- Choose an injection site: Ozempic is usually injected into the abdomen, thigh, or upper arm. Your healthcare provider will advise you on the best site for you. Rotate injection sites to prevent irritation or lumps from forming.
- Administer the injection: Clean the injection site with an alcohol swab and let it dry. Pinch the skin around the injection site and insert the needle at a 45-degree angle or as directed by your healthcare provider. Inject the medication as instructed, and then remove the needle. Apply gentle pressure to the injection site with a cotton ball or clean tissue if needed.
- Follow the recommended dosage: Ozempic is typically started at a lower dose and gradually increased to the desired maintenance dose. Your healthcare provider will determine the appropriate dosage for you and provide instructions on when and how to increase it.
- Monitor your blood sugar levels: Regularly monitor your blood sugar levels as recommended by your healthcare provider. This will help you and your doctor assess the effectiveness of Ozempic and make any necessary adjustments to your treatment plan.
- Attend follow-up appointments: Schedule regular follow-up appointments with your healthcare provider to evaluate your progress, address any concerns or side effects, and make any necessary adjustments to your treatment plan.
What home remedies can lighten skin, including acanthosis nigricans?
You may consider the following skin lightening strategies, however be aware that most do not work for AN. I have listed these home remedies from most sensible to least sensible- most dangerous & stupid.
While there are various methods to lighten skin, it’s important to note that everyone’s skin is different, and results may vary. It’s crucial to take a cautious approach and consult with a dermatologist or skincare professional before attempting any skin-lightening methods. Here are some potential home remedies that people have used to lighten their skin:
- Exfoliation: Regular exfoliation can help remove dead skin cells and promote a brighter complexion. Use a gentle exfoliating scrub or make your own by combining natural ingredients like sugar, honey, or oats. Gently massage the scrub onto your skin in circular motions, then rinse off with water. Start with salicylic acid 2% wash daily.
- Sunscreen, especially if acanthosis affects the face or sides of the neck.
- Vitamin C as tolerated. Catch 22 as it can reduce pigmentation but can cause significant skin irritation.
- Azelaic acid. Can work in less than 10% of cases. Better tolerated than retinoids.
- Vitamin A or retinol can be tried. Apply nightly to dark patches.
- Lemon juice: Lemon juice contains natural bleaching properties due to its high vitamin C content. Apply fresh lemon juice to the skin using a cotton ball, leave it on for about 15 minutes, and then rinse off with warm water. Be cautious as lemon juice can cause skin irritation and should not be used on open wounds or sensitive skin. It will cause worse skin pigmentation if exposed to UV light.
- Aloe vera: Aloe vera gel is commonly used for its soothing and hydrating properties. It may also help in lightening the skin. Apply fresh aloe vera gel to the skin and leave it on for about 20 minutes before rinsing off with water.
- Turmeric: Turmeric has been used for centuries in traditional skincare practices for its potential skin-lightening effects. Mix turmeric powder with a small amount of water or milk to form a paste. Apply the paste to the skin, leave it on for 15-20 minutes, and then rinse off with lukewarm water. However, turmeric can stain the skin temporarily, so use it with caution.
Remember, these remedies may not work for everyone, and results may take time. Additionally, it’s crucial to protect your skin from excessive sun exposure by using sunscreen with a high SPF, wearing protective clothing, and avoiding prolonged periods in direct sunlight. If you have concerns about your skin or desire significant skin lightening, it’s best to consult with a dermatologist for professional advice and guidance.
Davin’s viewpoint: treating acanthosis nigricans
Tricky condition to manage as there are two underlying causes, namely genetics & in over 80% of cases, highish BMI. Other factors come into play including PCOS & glucose intolerance (prediabetes).
The biggest traction is reduction of weight (if this is present). Most require pharmacological management, a few can do it with diet. Metformin orally at 1000 to 1500 mg can be considered as adjunctive treatment in those who have high BMI & or impaired sugars. This should be supervised by a GP or an endocrine specialist.
- Topical treatments: Certain creams or ointments may be prescribed to help lighten the affected areas and improve the texture of the skin. These may include topical retinoids, such as tretinoin, or creams containing ingredients like urea or salicylic acid. A starting point is salicylic acid & retinol.
- Cosmetic procedures: In certain instances, cosmetic procedures like chemical peels, laser therapy, or microdermabrasion may be recommended to improve the appearance of the affected skin. These procedures should be performed by a qualified dermatologist or skin care professional.
- Lasers: can be effective in some. Still hit and miss, despite optimal technology. Pico or nano QSL are superior to fractional-Fraxel lasers. IPL or BBL is risky & can lead to skin burns, especially in darker skin types. Lasers are best combined with skin care & medical management.
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