Integrative Medicine Approach to Acanthosis Nigricans: Specialty Testing, Dietary Modifications and Cosmetic Treatment Options

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. Treating this condition frequently requires an integrative approach, combining changes in lifestyle, diet, cosmetic interventions, and the use of medications to control and reverse. Thankfully, treating the underlying cause can significantly improve this condition- if not resolve it entirely. In this article, we will discuss what acanthosis nigricans is, what causes it, and also take a look at how to manage (and hopefully) get rid of 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 fails to respond effectively to insulin, causing an increase in skin cell reproduction and, ultimately, the formation of skin patches. Insulin resistance is also a precursor to type 2 diabetes, implying 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 induce acanthosis nigricans, including high-dose niacin, birth control pills, and corticosteroids. These medicines are known to influence hormone levels, triggering abnormal skin cell proliferation (5).

Less commonly, specific types of cancers can lead 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 precipitates 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 the first-line therapy. 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 Treatment

As acanthosis nigricans is often related to dysregulated insulin levels and obesity, a diet that takes this into consideration is paramount. Eating a nutrient-dense diet focused on maintaining steady insulin levels and avoiding processed foods can help to resolve this disease by attending to the underlying cause.

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 aids 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, can help reduce insulin resistance, while low-fat dairy products can provide essential calcium and protein with fewer calories (17). 

Supplements and Herbs For Acanthosis Nigricans Treatment

For patients interested in supplements and herbs, there are various evidence-based solutions that may help reduce symptomatology.

Berberine for Acanthosis Nigricans

Berberine is frequently used for patients who wish to steady 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 lowering 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 decrease weight 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 reverse the disease, a regular exercise regimen should play a part in treatment. 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 treatment directed toward this disease or the underlying condition 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 disease 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 disease 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 to reverse the condition by treating the underlying cause. All in all, while it can be an embarrassing and troubling issue for many patients, it can be resolved with these changes.