Dr. Heather Woolery-Lloyd discusses approaches for treating facial acanthosis nigricans in children and adults.
Heather Woolery-Lloyd, MD, Director of the Skin of the Color Division at the University of Miami Miller School of Medicine Department of Dermatology
Miami, Florida.
“Acanthosis nigricans is … increasing in incidence because it is more commonly seen in patients who are overweight or obese. Oftentimes when acanthosis nigricans presents on the face, it can be thought to be something else, like post-inflammatory pigmentation or melasma,” said Heather Woolery-Lloyd, MD, who presented “Approach to Treatment of Acanthosis Nigricans in the Skin of Color Patient” at the Diversity in Dermatology 2022 Conference.
“We need to capture those patients and treat them appropriately because they don’t respond to the traditional treatments for hyperpigmentation.”
Investigators looked for signs and symptoms of metabolic syndrome in a study of 100 patients with facial acanthosis nigricans,1 said Dr. Woolery-Lloyd.
“In that study of mainly men, 21% were overweight and 61% were obese; 52% had a high waist circumference, 74% had high body fat percentage, 50% had low HDL, and 38% had hypertriglyceridemia.”
“This very much mimics what I see in practice with acanthosis nigricans. Of course, we always check their fasting glucose and hemoglobin A1c.”
Acanthosis nigricans also commonly occurs in children, said Dr. Woolery-Lloyd.
“In one study, 28% [of 8th graders] in Texas, California, and North Carolina had acanthosis nigricans.2 So not only do I see it in my adult patients, but I will have young teenagers who present with a chief complaint of acanthosis nigricans. It’s something that’s even more challenging to treat in young people because their skin is a little more sensitive.”
Treatment Options
Although acanthosis nigricans can be treated with a topical, a change in lifestyle is ideal, said Dr. Woolery-Lloyd.
“Acanthosis nigricans resolves with weight loss. There are quite a few studies, especially in the gastric bypass world, which show that in the patients who undergo gastric bypass and lose significant amounts of weight, their acanthosis nigricans resolves, and even specifically facial acanthosis nigricans. In my practice, I definitely see that all the time.”
According to Dr. Woolery-Lloyd, when treating acanthosis nigricans patients with a topical, she uses a keratolytic agent.
“I’ll use something like ammonium lactate. I might start with 6% instead of 12%. Or a salicylic acid lotion. But the key take home is to use those sparingly, so I might start the patient on twice-a-week dosing and then increase it as needed. A lot of patients cannot tolerate a keratolytic on the neck or the face every single day. I tend to use the ammonium lactate on the body areas, specifically the neck.”
In some cases, topical retinoids can be used to treat facial acanthosis nigricans, as long as patients are moisturizing and using cosmeceuticals to prevent skin irritation, she said.
“I also try to address the pigment but that change in the skin is really multifactorial. It’s not only the hyperpigmentation but that velvety change that we’re trying to return back to normal skin. So, for the neck, I might use ammonium lactate or salicylic acid lotion, starting two to three times a week and increasing as tolerated. For the face, I would be more likely to use cosmeceuticals and a retinoid to help with the textural changes that occur with acanthosis nigricans.”
The big take home for dermatologists is the need to discuss lifestyle changes with acanthosis nigricans patients because that is definitive treatment, said Dr. Woolery-Lloyd.
“I do discuss … diet and exercise and explain that [acanthosis nigricans] is another motivator to try to lose weight.”
Disclosures:
Dr. Woolery-Lloyd receives grant and research support from Allergan, Arcutis, Eirion Therapeutics, Galderma, Merz, and Pfizer. She is a consultant or advisory board member for Arcutis, CLUE, Incyte, L’Oreal, and Merz. She is on the speakers’ bureau for EPI, L’Oreal, and Ortho Dermatologics. Dr. Woolery-Lloyd is a shareholder of Somabella Laboratories LLC.
References:
- Sinha P, Bhatnagar A, Bhattacharjee S, Tripathy DM, Yadav AK. A study of body mass index, waist circumference, body fat percentage, blood sugar levels, and lipid profile in patients of facial acanthosis Nigricans. Med J DY Patil Vidyapeeth 2020;13:335-40.
- Rafalson L, Pham TH, Willi SM, et al. The association between acanthosis nigricans and dysglycemia in an ethnically diverse group of eighth grade students. Obesity (Silver Spring). 2013;21(3):E328-E333. doi:10.1002/oby.20129.