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A mother brought her 16 year old daughter in for the treatment of dark patches around her neck. Initially, the mother thought it was due to poor hygiene, but came to believe that it was from hyperpigmentation, but bleaching creams (hydroquinone-containing) were not helping at all. The condition has been present, progressively over the past 2 years. She reports a significant weight gain by her daughter over the past 3 years. She is otherwise healthy.
What is your diagnosis? 

Acanthosis nigricans.
16 year old girl with a

Acanthosis Nigricans.
This is usually associated with an endocrinopathy often obesity and subclinical/pre-diabetes. This is commonly seen in the axillae and around the neck in adolescents who are overweight.

Weight control/reduction. Bleaching agents do not work because histologically, there is no melanin increase. The thickened skin folds give the illusion of hyperpigmentation. The most effective treatment is weight reduction and metabolic control. I tell the patients that bleaching creams will not work and I send all patients for primary care evaluation with the consideration of endocrine consultation.

Malignancy Associated Acanthosis Nigricans:
There is another version of acanthosis nigricans that used to be called malignant acanthosis nigricans associated with gastric carcinoma. This usually occurs in middle age adults. The lesions come on very fast and they are velvety plaques in the axillae and the is there is also oral mucosal involvement (as seen in the picture below) . This oftentimes can precede the diagnosis of gastric carcinoma by several months and also can be a harbinger for its return.

Acanthosis Nigricans on the Cheeks

Acanthosis Nigricans on the Anterior Neck

Acanthosis Nigricans on the Posterior Neck

Acanthosis Nigricans on the Inguinal Folds

Acanthosis Nigricans in axilla

Acanthosis Nigricans on central chest

Acanthosis Nigricans at angle of mouth

Acanthosis Nigricans on knuckles

Acanthosis Nigricans on posterior neck

Acanthosis Nigricans on upper inner thigh

Acanthosis Nigricans on nares

Acanthosis Nigricans Associated with Gastric Carcinoma (Malignancy Associated Acanthosis Nigricans)


Charles E. Crutchfield III, MD
Clinical Adjunct Associate Professor of Dermatology
At the
University of Minnesota Medical School
Medical Director, Crutchfield Dermatology


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