Case of the Month 
with Crutchfield Dermatology

Friday, March 1, 2013

A mother brought her 16-year-old daughter in for treatment of dark patches around her neck.  The mother initially thought they were due to poor hygiene but came to believe the patches resulted from hyperpigmentation. However, hydroquinone-containing bleaching creams were not helping at all. The condition had been present more than two years, and the mother reported her daughter experienced significant weight gain during the past three years. She was otherwise healthy.

What is your diagnosis?

Diagnosis: Acanthosis Nigricans

This is usually associated with an endocrinopathy — often obesity and subclinical or prediabetes. It is commonly seen in the axillae and around the neck in adolescents who are overweight.

Treatment: 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 patients with this condition that bleaching creams will not work and send them to primary care physicians for 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-aged adults. The lesions appear in the axillae very fast and resemble velvety plaques. This is accompanied by oral mucosal involvement and oftentimes can precede the diagnosis of gastric carcinoma by several months and can also be a harbinger for its return.

For more information, contact Charles E. Crutchfield III, M.D., at Crutchfield Dermatology or visit www.CrutchfieldDermatology.com.