Can metformin cure acanthosis nigricans?

Indicators of diabetes on your skin

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Acanthosis nigricans is a skin disease that commonly occurs on the skin folds of obese people or those suffering from insulin resistance. Treatment focuses on resolution of the underlying disease causing the velvety, hyperpigmented, hyperkeratotic state. While the main goal of therapy is to treat the underlying cause, cosmetic resolution of AN lesions can be valuable for patients and their quality of life. Treatment options have not been broadly studied. Metformin is a drug used to treat conditions characterized by insulin resistance.

What is acanthosis nigricans and what can be done about it?

A look at treatment options for acanthosis nigricans

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Acanthosis nigricans (AN) is a dermatologic manifestation of systemic disease linked with insulin resistance, diabetes, obesity, internal malignancy, endocrine problems, and drug reactions.  Acanthosis nigricans (AN) is characterized by thick velvety hyperpigmented plaques of the skin. When AN is connected to an internal malignancy, skin changes develop quickly and are often followed by mucosal involvement, seborrheic keratoses, papillomas, and tripe palms. In contrast, endocrinopathy-related AN develops more gradually and covers a smaller area. Patients are mostly obese and may have a family history of diabetes or polycystic ovarian syndrome (PCOS). This condition presents in all races.The severity of AN has a direct correlation with fasting insulin levels. AN is possibly the result of high insulin levels binding to insulin-like growth factor 1 receptors (IGF-1Rs) on keratinocyte and fibroblast cells. This leads to a rapid increase of both cell types and the appearance of plaques and papillomatosis. Also, the high levels of insulin raise the amount of circulating free IGF-1, which causes keratinocyte growth and differentiation.

Treatment of AN should center on addressing the underlying disease

A decrease in weight in obesity-related AN can help fix hyperkeratotic lesions, while the improvement of hyperinsulinemia can lessen the burden of AN lesions. Cessation of the medicine in drug-induced AN often ends in the healing of AN,  Surgical removal of tumors is the backbone of treatment in malignancy-linked AN. While AN therapy aims to treat the primary cause, cosmetic fixing of AN lesions is significant for a patient and their quality of life. 

What is Metformin?

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Metformin (also known as Glucophage®) helps regulate the amount of glucose (sugar) in your bloodstream. It makes your body more receptive to insulin and reduces the quantity of glucose your liver releases. Young women with high insulin who use Metformin are less likely to get type 2 diabetes than those who don’t take any medication that lowers insulin. Research has shown that young females with PCOS who are overweight and were treated with Metformin with a healthy lifestyle, good nutrition, and regular exercise were able to lose weight and decrease their fasting blood sugar levels. Taking Metformin and retaining a healthy weight also influences cholesterol levels. 

Metformin and rosiglitazone for treating AN

For the therapy of AN associated with insulin resistance, conventional insulin-sensitizing agents like metformin can be used. Metformin boosts peripheral insulin responsiveness, resulting in lower glucose generation, hyperinsulinemia, body weight, and fat mass, including an increase in insulin sensitivity in cases with insulin resistance and AN. One recent clinical trial conducted in India treated 40 patients with acanthosis nigricans and insulin resistance with 500 mg metformin thrice every day for three months. Compared with 20 control patients who were administered with placebos, patients given metformin showed statistically and clinically notable improvement in AN of the neck and axilla, but not in acanthosis nigricans of the knuckles, fingers, or elbows. In one published case, three obese teenage patients were put on metformin and dietary changes. All the patients had earlier failed topical therapy for AN, either with calcipotriol or with corticosteroids. Improvement was inherently seen in all the three patients with no relapse of AN reported after one year of completing medication.A prospective, blind, open-label trial compared metformin and rosiglitazone in 27 insulin-resistant subjects for 12 weeks. While a greater decrease in fasting insulin levels was observed with rosiglitazone, only minimal change in AN lesions and skin texture was observed with either agent. Duration of treatment also plays a part in seeing clinical improvements to the epidermis, as metformin does improve both AN and insulin resistance when taken for 6 or more months. In a smaller 6-month trial of metformin use in patients with AN and insulin resistance, improvement in acanthosis nigricans resulted in three of five patients (two adolescents and one adult).

How do I take Metformin?

It is available in pill or liquid form. It is taken 2–3 times a day with your meals. Your doctor should tell you to start with a very low dose and slowly up the amount you take over a few months. Your doctor can prescribe a once a day long-acting (XR–extended release) Metformin pill instead. It’s crucial that you take this medication exactly as prescribed by your physician. Don’t break, chew, or crush the pills, swallow them whole.

How do one store Metformin?

Keep your Metformin medication tightly closed, in the same bottle you purchased it in. Don’t remove the label on the bottle either. Keep it at room temperature away from high temperatures, sunlight and any moisture. Do not keep Metformin in the bathroom cabinet. Be sure to keep your medication away from children.

Are there any reasons not to take Metformin medication?

Persons with kidney or liver issues should not take Metformin

Your doctor should check your blood to ensure that you don’t have blood, kidney or liver problems before you start using Metformin and keep checking these levels annually with continued use. If you get nausea or have diarrhea, call your physician and stop using Metformin until you feel better. 

It’s important to keep hydrated while taking Metformin

You should not drink alcohol and take Metformin. If you’re going to have surgery, a medical or dental procedure where you cannot have anything to eat or drink, consult your doctor about ceasing the use of Metformin for about 48 hours before the procedure. If you are to have an X-ray that includes the use of a “contrast material” which is a dye that assists the radiologist to see the images better, talk to your doctor about stopping your Metformin medication for up to 48 hours before and after taking the test.  Getting dehydrated, having kidney issues, or having a serious infection can trigger a rare condition called “lactic acidosis,” so it’s critical to talk to your health care provider about any of these issues.

Does Metformin have any known side effects?

Generally, healthy young people don’t get many side effects. About a third of patients who take Metformin get stomach upset like nausea, diarrhea, gas, and low appetite. Others complain of having a metallic taste in their mouth. If the side effects are too much for you, it’s important to tell your health care provider. They can alter your dose and slowly build back up to the regular dose. 

How to tighten skin?

To make our skin tighter, eat healthily, exfoliate your skin, limit UV exposure, and use

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