Acanthosis nigricans is more than just a skin condition. Oftentimes, it can be like a canary in a coal mine, signifying other health conditions related to insulin resistance, such as diabetes or obesity. It is relatively common, affecting approximately 20% of the US population. Managing this condition often requires an integrative approach, combining changes in lifestyle, diet, cosmetic interventions, and the use of medications to help manage symptoms. Addressing the underlying factors may significantly improve this condition. In this article, we will discuss what acanthosis nigricans is, what causes it, and also take a look at how to manage it!
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What is Acanthosis Nigricans?
Acanthosis nigricans typically manifests as dark, thick patches on the skin. These patches can occur anywhere but are particularly prominent in areas with skin folds, such as the neck and armpits.
Causes And Risk Factors For Acanthosis Nigricans
Acanthosis nigricans is frequently linked to insulin resistance. This resistance happens when the body does not respond effectively to insulin, which may contribute to an increase in skin cell reproduction and, ultimately, the formation of skin patches. Insulin resistance is also a precursor to type 2 diabetes, suggesting a complex relationship between this skin condition and metabolic disorders. As this condition is closely related to metabolic disorders, associated conditions may include those increasing cardiovascular disease risk (5).
Furthermore, certain medications can be associated with acanthosis nigricans, including high-dose niacin, birth control pills, and corticosteroids. These medicines are known to influence hormone levels, which may trigger abnormal skin cell proliferation (5).
Less commonly, specific types of cancers can be linked to acanthosis nigricans. These include lymphoma, stomach cancer, colon cancer, and liver cancer. The hormonal imbalances caused by these malignancies may stimulate the development of this skin condition. Obesity is another noteworthy risk factor for acanthosis nigricans, as it often precedes insulin resistance. This connection reiterates the profound interplay between metabolic health and the skin's condition (5,6).
Clinical Presentation And Symptoms of Acanthosis Nigricans
Acanthosis nigricans manifests through several distinctive signs and symptoms, which primarily include the emergence of dark, thick, velvety skin in the folds and creases of the body. Most notably, this skin condition often makes its presence known in areas like the armpits, groin, and the back of the neck. Skin changes develop gradually, which is another notable characteristic. The impacted skin may also exhibit other symptoms, including itchiness, skin tags (small skin outgrowths), or a foul odor (5,6).
How is Acanthosis Nigricans Diagnosed?
The diagnosis of acanthosis nigricans is made following a skin examination. While it’s usually fast and simple, providers might take a skin biopsy in order to examine the skin under a microscope to confirm the diagnosis and rule out other similar skin conditions (5).
Functional Medicine Labs to Test That Can Help Individualize Treatment for Acanthosis Nigricans
Functional medicine labs offer a variety of tests that can help tailor treatment to patients, allowing providers to optimize management strategies.
Diabetes Testing
This panel is excellent for understanding your insulin and glucose levels which are major players in acanthosis nigricans (5,6).
Stool Testing
This test checks for bacterial overgrowth and parasitic infections, which could be causing gut inflammation. A calm gut could help your body better manage insulin, potentially reducing symptoms.
Hormone Testing
This test checks out key hormones that could be out of balance, such as cortisol, which is linked to insulin resistance.
Lipid Testing
This panel is a deep dive into your lipid levels. If you've got irregular lipid levels, it could affect your insulin levels, making it an excellent test to consider when dealing with acanthosis nigricans.
Hs-CRP Testing
With obesity being a risk factor for acanthosis nigricans and heart disease, this test, which measures inflammation and cardiovascular risk, is worth a look to evaluate associated decreases in heart health.
Cosmetic Treatments For Acanthosis Nigricans
For those seeking cosmetic solutions to acanthosis nigricans, topical retinoids are often considered. As demonstrated in numerous patients, this treatment begins to show notable improvements after just two weeks. However, continual application may be necessary to maintain these benefits over time. Another type of topical treatment, vitamin D analogs, is thought to provide relief by reducing the cosmetic effects of insulin. For individuals open to a slightly more invasive approach, chemical peels, particularly those utilizing Trichloroacetic acid (TCA), can lead to significant advancements in hyperpigmentation, skin thickening, and overall appearance. Other options include laser treatments, oral retinoids, or metformin/rosiglitazone.
Integrative Dietary Modifications For Acanthosis Nigricans Management
As acanthosis nigricans is often related to dysregulated insulin levels and obesity, a diet that takes this into consideration is important. Eating a nutrient-dense diet focused on maintaining steady insulin levels and avoiding processed foods may help manage this condition by attending to the underlying factors.
Aim for a large intake of vegetables, particularly dark green, leafy ones like spinach, due to their low-calorie count and high nutrient content. However, it's important to be mindful of starchy vegetables, like potatoes, peas, and corn, due to their higher carb content. Adding a variety of fruits into your diet, as they're loaded with vitamins, minerals, and fiber. Try swapping fruits for sweets to manage cravings, and stick to fresh fruits instead of canned ones with added syrup (17).
High-fiber foods such as almonds, black beans, broccoli, lentils, and oatmeal are recommended because the consumption of more than 50 grams of fiber per day may aid in blood sugar balance. Selecting lean proteins, such as skinless chicken or turkey, certain fish, low-fat cheese and egg whites, and plant-based proteins like beans, lentils, and nut butters, can help to maintain adequate protein intake while limiting fat consumption. Lastly, healthy fats, such as olive, sunflower, and sesame oils, may help support insulin sensitivity, while low-fat dairy products can provide essential calcium and protein with fewer calories (17).
Supplements and Herbs For Acanthosis Nigricans Management
For patients interested in supplements and herbs, there are various options that may help support overall health.
Berberine for Acanthosis Nigricans
Berberine is frequently used for patients who wish to support healthy blood sugar levels. Additionally, it has also been shown to help patients improve their lipid profiles (2).
Dose: 0.4-1.5 grams daily
Duration: 2 years
Green Tea Extract for Acanthosis Nigricans
A meta-analysis on the subject showed that regular caffeinated green tea (“catechin-caffeine”) increased fat loss compared to placebo. Additionally, green tea extract has shown benefits in supporting healthy lipid levels and possibly reducing heart disease risk.
Dose: 400-500mg/day or approximately 8 cups of green tea
Duration: As symptoms persist
Vitamin D for Acanthosis Nigricans
Vitamin D has been shown to significantly support weight management and waist circumference (2).
Dose: 50,000 IU per week
Duration: 6 weeks
The Importance of Physical Activity and Exercise for Patients With Acanthosis Nigricans
While regular physical activity is an important part of general health, it is especially important for those with acanthosis nigricans. As losing weight can often help manage the condition, a regular exercise regimen should play a part in management. According to the CDC, in order to lose weight and keep it off, you need to incorporate a “high” amount of physical activity. This also includes changing your diet, as discussed above, as losing weight also necessitates healthier eating. To maintain your weight goals, it's recommended to get 150 minutes of moderate-intense exercise per week.
Patient Education and Support
For patients and providers alike, it's important to understand that the skin hyperpigmentation associated with acanthosis nigricans may not just be a skin issue; it can indicate an underlying condition, especially in middle-aged to elderly individuals. As discussed, however, the good news is that management directed toward this condition or the underlying factors can often improve or even resolve skin changes. Awareness of risk factors and symptoms of potentially serious conditions, such as malignancies linked with acanthosis nigricans, can allow for proper monitoring and prevention. Furthermore, it's important to address the possible mental health aspect. The presence of this condition can many times lead to depression and low self-esteem. In these cases, seeing a mental health professional can provide patients with an extra level of support.
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Summary
In summary, acanthosis nigricans is not only a skin condition but also a sign of underlying health issues. Characterized by dark, thick patches on the skin, this condition is frequently associated with conditions related to insulin resistance - such as diabetes or obesity. Less frequently, it can be a result of certain medications or malignancy. An integrative approach combining testing, medications/supplements, diet changes, and physical activity can help manage the condition by addressing the underlying factors. All in all, while it can be an embarrassing and troubling issue for many patients, it can be managed with these changes.
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