Acanthosis nigricans treatment

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
  • Cost$-$$

Acanthosis nigricans

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. 

The lasers we use at Cutis Dermatology Brisbane & DVP in Sydney are safe in darker skin types. 

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.

From there- 

  • 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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