Diabetes and your skin
- 1 Diabetes and your skin
- 2 What is acanthosis nigricans?
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Acanthosis nigricans is a fairly prevalent skin pigmentation disorder. The most noticeable sign of acanthosis nigricans is the dark patches of skin with thick, velvety texture. The affected patches of skin may also itch or have an odor. Acanthosis nigricans can happen to healthy people, but it may be a sign of a more grave health problem, such as prediabetes. The most useful treatments center on finding and resolving the underlying medical conditions. These skin patches tend to disappear after the successful treatment of the root cause.
What is acanthosis nigricans?
Understanding acanthosis nigricans
Acanthosis nigricans or AN, in short, is a condition common in people who have type 2 diabetes. It causes darkened and hardened skin, especially in skin folds. It looks like a small wart. The skin becomes tan or brown. It is sometimes slightly raised and may look velvety. These folds can be found on the:
- neck area
- under the lips
- on the palms
- on the soles of the feet
- Sometimes, the top of your knuckles might look strange
Classification of acanthosis nigricans
Acanthosis nigricans is divided into either benign and malignant forms, although it may be divided into syndromes according to the cause:
- Benign – This may cover obesity-related, hereditary, and endocrine kinds of acanthosis nigricans.
- Malignant – This may comprise of forms that are linked with tumors and insulin-like activity, or tumor necrosis factor. An alternate classification system still used to represent acanthosis nigricans delineates AN syndromes according to their associated causes, including benign and malignant forms, types associated with obesity and drugs, acral AN, unilateral acanthosis nigricans, and mixed and syndromic forms.
Who is at risk for acanthosis nigricans?
This condition appears in both men and women. This condition normally affects people who are very overweight, have darker skin, and have diabetes or prediabetic conditions. It usually starts before diabetes occurs, and it can be an indicator of insulin resistance. While there’s no cure, losing some weight may help. Children who get acanthosis nigricans are at a greater risk of developing type 2 diabetes later in life.The incidence of acanthosis nigricans differs between ethnic groups. According to the American Academy of Dermatology, persons of African, Caribbean, or Hispanic descent are also at a higher risk. All races are evenly at risk of getting acanthosis nigricans when body mass index (BMI) is above normal.
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What triggers acanthosis nigricans?
Acanthosis nigricans skin patches happen when epidermal skin cells start to reproduce rapidly. This abnormal cell growth is triggered by high levels of insulin in the blood. In a few cases, the increase in skin cells may be triggered by medications, cancer, or other underlying medical conditions.
Too much insulin in the body
The most frequent trigger for AN is the high insulin levels in your bloodstream. When you eat, your body turns carbohydrates into sugar molecules like glucose. Some of this glucose is used to energize your cells while the rest is stored. The insulin hormone allows the glucose to enter the cells so that they can use the glucose for energy. Overweight persons tend to develop resistance to insulin over time. Although the pancreas keeps making insulin, the body can’t use it well. This causes an accumulation of glucose in the bloodstream, which can result in higher levels of both blood glucose and insulin in your blood.Excess insulin causes normal skin cells to multiply at a rapid rate. For those with darker skin, these new cells contain more melanin. This increase in melanin creates a patch of skin that is darker than the skin surrounding it. Thus, the appearance of acanthosis nigricans is a strong predictor of future diabetes. If too much insulin is indeed the problem, it’s relatively easy to correct this with a proper diet, exercise, and blood sugar control.
Obesity and pseudoacanthosis nigricans
In young people, acanthosis nigricans is a visible sign which strongly suggests insulin resistance. High levels of insulin in the blood causes the growth of darkened skin over specific areas of the body. No skin remedy will get rid of AN. Acanthosis nigricans may lighten up and maybe go away by curing the root cause, insulin resistance, but this can take months or years to do so. Insulin resistance syndromes may be split into type A (HAIR-AN) and type B syndromes. Most cases of acanthosis nigricans are linked with obesity and otherwise idiopathic. This is likely due to insulin resistance, and more prone to occur in darker-skinned persons. This can also be called pseudoacanthosis nigricans.
AN can also be triggered by certain medications like birth control pills, human growth hormones, thyroid medication, and even some bodybuilding supplements. All of these medications can cause fluctuations in insulin levels. Medications used to relieve the side effects of chemotherapy have also been linked with acanthosis nigricans. In most instances, the condition clears when the medications are discontinued.
Familial acanthosis may arise due to an autosomal dominant trait, presenting at birth or developing during childhood.
Endocrine symptoms linked with acanthosis nigricans can develop in many conditions like:
- begins with insulin resistance, like diabetes mellitus and metabolic syndrome
- excess circulating androgens, especially with Cushing’s disease, acromegaly, or polycystic ovarian disease
- Addison’s disease or hypothyroidism
- in rare diseases, like pinealoma, leprechaunism, lipoatrophic diabetes, ovarian hyperthecosis, stromal luteoma, ovarian dermoid cysts, Prader-Willi syndrome, and Alström syndrome.
- Acanthosis nigricans linked with endocrine dysfunction is more insidious in its start, is less widespread, and the patients are often concurrently obese.
Malignant acanthosis nigricans refers to AN occurring as a paraneoplastic sign associated with a form of cancer. Malignant AN is most commonly linked with gastrointestinal adenocarcinomas, as well as genitourinary cancers like those of the prostate, breast, or ovary. Other kinds of cancers, such as those of the lung, stomach, and lymphoma, are occasionally connected to the occurrence of acanthosis nigricansThis sort of acanthosis nigricans is more likely to involve the mucous membranes (25-50% of the cases). Malignant acanthosis nigricans can either precede (18%), accompany (60%), or follow (22%) the start of internal cancer. Malignancy-linked acanthosis nigricans is has accelerated onset and may be accompanied by skin tags, multiple seborrheic keratoses, or tripe palms.
Acral acanthotic anomaly
Acral acanthotic anomaly is a variant of AN limited to the elbows, knees, knuckles, and dorsal surfaces of the feet, in the lack of any other findings, in otherwise healthy people. While the etiology remains unknown, its appearance does not suggest a likelihood of malignancy
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How is acanthosis nigricans diagnosed?
Acanthosis nigricans is clear to identify by sight. Your doctor may want to check for:
- Addison disease, a malady caused by a lack of hormones from the adrenal gland.
- Pituitary gland disorders in the brain.Growth hormone therapy.
- Hypothyroidism (which is indicated by low levels of thyroid hormone caused by the decreased function of the thyroid gland).
- Use of oral contraceptives.
- The use of some cholesterol medications, like nicotinic acid.
- Diabetes or insulin resistance
It’s crucial to inform your doctor about any dietary supplements, vitamins, or bodybuilding supplements you may be consuming in addition to any prescription medications. In rare cases, your doctor can perform other tests, like a small skin biopsy, to rule out other likely causes.
Symptoms of AN
Usually, the only signs of acanthosis nigricans will be dark, thick, velvety patches of skin in creases and folds, usually in the neck, armpits, or groin. But it’s sometimes found in the lips, palms, knuckles, soles of the feet, and other areas. In rare cases, children may have mild itching in the affected areas. The patches of skin will usually change color slowly, in months or even years. If your child’s skin changes color rapidly, call your doctor right away. It could indicate an underlying medical condition.
How is acanthosis nigricans treated?
Acanthosis nigricans is not a disease. It can be a sign of a hidden medical condition that may require medical attention. Treatment is largely concentrated on addressing the condition that’s causing it. If you’re overweight, your physician will advise you to lose weight. Your doctor may also prescribe medicine to help bring your blood glucose levels under control. If the condition is as a result of using certain medications or supplements, your physician may have you discontinue them or recommend substitutes. The discolored skin patches will usually fade away when you find the cause and get it under control or solved.
Cosmetic AN treatments
If you are disturbed about the look of your affected skin, there are cosmetic treatments available that can remedy that. Treatments include:
- applying skin lighteners, like Retin-A, 20% urea, alpha hydroxy acids, and salicylic acid
- using antibacterial soaps
- applying oral acne medications
- having laser therapy
These treatments can improve the look of the skin affected by acanthosis nigricans but will not cure the condition.
Ongoing care and prevention: Having a healthy lifestyle can prevent acanthosis nigricans. Losing excess weight, controlling your diet, and adjusting any medications that are contributing to the condition are all crucial steps in controlling this ailment.