Medication-Induced Acanthosis Nigricans
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Medication-Induced Acanthosis Nigricans is one amongst the 7 kinds of Acanthosis Nigricans. It takes place as a side effect to having medications, such as oral contraceptive tablets, steroids, niacin (nictonic acid), and lots of other medications.
Medication-Induced Acanthosis Nigricans is also referred to as:
- Drug-Induced Acanthosis Nigricans
- Drug-Induced AN
What is Drug-Induced Acanthosis Nigricans?
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Acanthosis Nigricans (AN) is a skin problem that causes thick, velvety, and darkened skin areas. This is because of the increased thickness of the epidermis. It commonly impacts the skin of the underarms, the groin region, head and neck, and anal/genital region. Acanthosis Nigricans is not infectious, and it can not be transmitted from one person to another. But, it is connected to many disorders, such as weight problems, diabetes, and malignancy.Medication-Induced AN is among the 7 kinds of Acanthosis Nigricans. It is a side effect of having some medications, such as steroids, oral contraceptive pills, niacin (nictonic acid), and many other medications. Drug-Induced Acanthosis Nigricans is usually identified by a physical examination and a thorough clinical history check. Despite the fact that it is a benign condition, consultation and screening from a dermatologist are essential to ascertain that the trigger of the acanthosis nigricans is actually the medication. Usually, when you stop taking the medications causing the problem, the lesions on the skin will start to disappear. For this reason, the prognosis of Medication-Induced Acanthosis Nigricans is typically good without any recognized complications.
Who gets Drug-Induced Acanthosis Nigricans?
Drug-Induced Acanthosis Nigricans is triggered by the use of specific medications. People who take such medications are at risk of getting this condition. It can impact both males and females. Unlike the other causes of acanthosis nigricans, drug-induced AN has no preference for any ethnic group or a specific race; as long as you take those drugs, you are at risk.
What are the Risk Factors for Medication-Induced Acanthosis Nigricans?
The main risk factor for medication-induced AN is using specific drugs or creams that trigger the condition as a side effect. The following medications are the recognized threat for triggering Drug-Induced Acanthosis Nigricans:
- Estrogen, oral contraceptive pills
- Steroids
- Nicotinic acid (niacin)
- Insulin
- Hormones preparations
- Protease inhibitors
The medications above are the usual suspects. However, there are many other medications that may cause the very same effect. You should also remember that having a risk factor does not necessarily mean that one will get the condition. It only means that your chances of getting acanthosis nigricans increases compared to an individual without the risk factors.Conversely, if you do not have the risk factors, it does not imply that you will not get the condition. It is constantly essential to talk about the result of risk factors with your doctor.
What are the Causes of Drug-Induced Acanthosis Nigricans?
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Medication-Induced Acanthosis Nigricans is caused by the following: Medications, such as steroids, estrogen, oral contraceptive pills, insulin, nicotinic acid (niacin), protease inhibitors, and certain hormones. The condition can be defined as a negative reaction of the body to certain medications that are utilized for various conditions. This leads to the formation of lesions on the skin.Researchers believe these medications cause increased levels of insulin secretion, which plays a part in the advancement of Acanthosis Nigricans, just as in the other types of this condition.
What are the Signs and Symptoms of Medication-Induced AN?
The symptoms and signs of Drug-Induced Acanthosis Nigricans are as follows:
- The most obvious sign is the formation of hyperpigmented, silky skin lesions, that form on the skin folds such as the back of the neck, the groin, and axilla.
- The hyperpigmentation is usually black or brown.
- The intensity of the signs and symptoms might be associated with the usage of the drug.
- These individuals are typically healthy.
How is Drug-Induced Acanthosis Nigricans Diagnosed?
The following may be utilized to diagnose Drug-Induced Acanthosis Nigricans: A thorough evaluation of the individual’s case history and a total physical examination.
Throughout history-taking, the doctors might inquire about the following:
- When the signs started and whether they are worsening.
- List of prescription and over-the-counter medications presently being taken.
- About one’s family history of cancer, thyroid abnormalities, diabetes, ovarian and adrenal gland problems, etc.
Given that specific kinds of Acanthosis Nigricans can be related to diabetes, cancer, or weight problems, and thus, workup for these conditions may be shown if medical conditions necessitate the same.A skin biopsy can sometimes be performed and sent to a lab for a pathological evaluation, who analyzes the biopsy under a microscope. After putting together medical findings, special research studies on tissues (if needed) and with microscope findings, the pathologist gets to a conclusive diagnosis.A skin biopsy is just rarely performed, when the diagnosis is doubtful, or if it looks like other similar skin conditions. Many clinical conditions might have comparable signs and symptoms. Your doctor might carry out additional tests to dismiss other clinical conditions to come to a definitive diagnosis.
What are the Possible Complications of Drug-Induced Acanthosis Nigricans?
The skin lesions of Drug-Induced Acanthosis Nigricans typically do not cause any medically-related problems, but it can result in low self-esteem due to cosmetic concerns.
How is Drug-Induced Acanthosis Nigricans Treated?
The treatment measures for medication-induced Acanthosis Nigricans might include the following:
Consultation with a dermatologist about acanthosis nigricans
It is often needed, as they are specialists in dealing with numerous skin problem.
Avoiding the drugs that are triggering acanthosis nigricans
Stopping the trigger medication many times can help resolve the condition.
Ruling out the other potential causes of acanthosis nigricans
Workup for cancer, diabetes, or obesity is needed, if scientific condition warrants it, or if the skin sores do not regress following discontinuation of the medication.
Treatment for acanthosis nigricans
Treatment for cosmetic reasons might be required if the skin lesions persist regardless of discontinuation of medication.
How can Drug-Induced Acanthosis Nigricans be Prevented?
You cannot completely prevent this condition from occurring. However, ceasing the medication or finding a harmless alternative will more than likely clear up the skin.
What is the Prognosis of Drug-Induced Acanthosis Nigricans?
The outcome of Drug-Induced Acanthosis Nigricans is very good. After you stop using the medication, there are no other significant complications.
Other reasons for acanthosis nigricans
What causes acanthosis nigricans?
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Apart from the discussed medication-induced acanthosis nigricans, there are other causes of acanthosis nigricans.
Excessive insulin can result in acanthosis nigricans
The most common cause of acanthosis nigricans is too much insulin in your blood. Your body usually converts carbohydrates into sugar molecules such as glucose when you eat. The glucose gives the cells energy while the rest is preserved. Insulin must permit glucose to go into cells so that the cells can use glucose for energy.Obese people gradually form a resistance to insulin. The insulin is still produced by the pancreas, but the body can’t utilize it effectively. This develops an accumulation of glucose in the bloodstream, which can result in high levels of both blood sugar and insulin in your blood stream.Excess insulin causes regular skin cells to reproduce very fast. The cells have more melanin in people with dark skins. This, therefore, means that there will be patches on the skin that are darker than the surrounding skin. Thus, acanthosis nigricans is a strong predictor of future diabetes. If you are sure that excess insulin is the cause of your acanthosis nigricans, then it is relatively easy to remedy with proper diet, controlling the blood sugar, and regular workout.
Rare causes of acanthosis nigricans
In rare cases, acanthosis nigricans can be brought on by:
- stomach cancer, or stomach adenocarcinoma
- low levels of thyroid hormones
- adrenal gland conditions, such as Addison’s illness
- high dosages of niacin
- disorders of the pituitary gland
How is acanthosis nigricans treated?
Acanthosis nigricans is a symptom of another condition that may require medical attention; it is not a disease by itself. Treatment is mainly focused on attending to the condition that’s causing it. If you are overweight, your doctor will recommend you reduce your weight. Your physician may also recommend medications that bring your blood sugar under control.If the condition is triggered by medications or supplements, the doctor can recommend alternatives and have you stop the current medications. The stained skin patches will normally fade when you find the cause and get it under control.
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Topical treatments of acanthosis nigricans
Topical retinoids for acanthosis nigricans
Topical retinoids are usually among the first treatment options for acanthosis nigricans. In a study of 30 acanthosis nigricans patients, improvements were seen in all patients after 14 days of 0.05% tretinoin application. Of the 30, 24 showed overall clearance at 16 weeks. Nevertheless, intermittent tretinoin was needed to maintain the results as relapse was noted within a duration of 4 weeks after discontinuation of treatment.
Topical vitamin D analogs for acanthosis nigricans
Calcipotriene is another topical treatment choice for acanthosis nigricans. The vitamin D analog is believed to have keratinocyte proliferation and promote differentiation. By minimizing the number of keratinocytes, it may lessen the cutaneous impacts of insulin.
Chemical peels for acanthosis nigricans
Superficial chemical peels are a relatively safe and effective treatment choice for acanthosis nigricans. Trichloroacetic acid (TCA) is a chemical exfoliating agent that triggers the destruction of the epidermis. This results in skin repair and rejuvenation. The destruction is followed by swelling and the activation of wound repair, triggering the formation of new smooth skin.
Oral treatment for acanthosis nigricans
Using oral retinoids (isotretinoin and acitretin) to deal with acanthosis nigricans. Oral retinoids such as acitretin and isotretinoin are viable treatments for acanthosis nigricans. However, improvement needs large dosages. It is suggested that these drugs work by normalizing the epithelial growth and differentiation.
Using metformin and rosiglitazone to deal with acanthosis nigricans
If the cause of acanthosis nigricans is the resistance to insulin, then the standard insulin-sensitizing agents like metformin are used. Metformin increases peripheral insulin responsiveness, leading to a reduction of hyperinsulinemia, glucose production, body weight, and fat mass, along with a boost in insulin sensitivity in patients with insulin resistance and acanthosis nigricans.
Other oral agents for acanthosis nigricans
Thiazolidines are medications that increase insulin sensitivity in peripheral muscles. Combining thiazolidines with metformin has also been reported to work for people with acanthosis nigricans. Hyperandrogenemia, insulin resistance, and acanthosis nigricans syndrome patients might likewise be treated with a mix of metformin and oral contraceptives.
Other therapies for acanthosis nigricans
Other treatments that have improved acanthosis nigricans include podophyllin, fish oil, and combination therapy with salicylic acid, urea, and triple-combination depigmenting cream. Fish oil has in some cases improved hyperpigmentation and skin texture. This is because it is rich in omega-3 fatty acids.
Podophyllin for acanthosis nigricans
Podophyllin 20% in alcohol has actually been reported to momentarily solve acanthosis nigricans sores of the hands. Other treatment choices that have been reported with variable outcomes include the application of salicylic acid and topical urea.
Alexandrite laser for acanthosis nigricans
Use of alexandrite laser is another cosmetic treatment choice that has been demonstrated to be effective in enhancing acanthosis nigricans sores. After seven treatments with long-pulsed alexandrite laser over 95% clearance in the left axilla was observed. This laser was developed to target melanin in the hair and was assumed to enhance the darkening of the skin in impacted areas. Although it is not economical compared to other topical and oral treatment alternatives, the use of alexandrite laser for treatment of acanthosis nigricans is a promising prospect.
