Acanthosis nigricans (AN) is a condition that causes dark and dry streaks or patches of skin, usually on the neck, underarms, and groin. This skin condition often occurs in overweight and obese individuals (including children), and may indicate an underlying medical condition (1).
The American Diabetes Association considers acanthosis nigricans as one of the likely indicators of insulin resistance and diabetes mellitus in children entering puberty (2) (3). Read this post to learn more about AN in children, its symptoms, treatment, and ways to prevent the condition.
Symptoms Of Acanthosis Nigricans In Children
- Symmetrical darkening (hyperpigmentation) and thickening (hyperkeratosis) of the skin.
- Streaks of black lines which are dark and have a roughened and velvety texture.
- No pain or discomfort, but might occasionally itch.
- The skin around these areas may look rough and dark.
- It commonly occurs around the folds on the skin, such as the neck, underarms, back of the knees, joints of the fingers, and inner thighs. It may also occur in the groin region.
- Less frequently, it might occur on the eyelids, face, palms, soles, and nipples.
Pictures Of Acanthosis Nigricans In Children
Pigmentation on the skin may also be due to sunburn or nutrient deficiency. Thus, it is necessary to identify the symptoms of AN. Here are a few pictures that might help.
Possible Causes Of Acanthosis Nigricans In Children
Here are some of the reasons why children could develop dark patches around the neck.
1. Insulin resistance
This is the most common reason for AN. The insulin hormone, secreted by the pancreas, helps the cells use glucose from the bloodstream. During insulin resistance, cells are unable to use insulin for glucose permeability. It leads to excess insulin and glucose in the bloodstream. Insulin resistance may occur due to several health conditions. Obesity or being overweight is one of the significant factors for developing insulin resistance.
Insulin resistance can lead to hyperpigmentation and thickening of the epidermal skin cells, resulting in acanthosis nigricans (6). Resistance to insulin also increases the risk of type II diabetes.
A rare form of AN known as unilateral acanthosis nigricans can occur in a child with a family history of AN. This is characterized by the appearance of lines over the face, chest, scalp, abdomen, back, and thighs. This type of AN may not indicate an underlying endocrine disorder (7).
3. Other causes
Long-term usage of medicines, such as oral contraceptive pills or artificial human growth hormones may cause AN. Rarely, AN could be a symptom of lymphoma or cancers associated with the gastrointestinal or genitourinary tract (8).
Who Are At A Higher Risk Of Developing Acanthosis Nigricans?
Not all children develop acanthosis nigricans; here are some of the risk factors which might increase the chances of developing AN in children.
- Obesity: Acanthosis nigricans is usually more common among obese children. Studies note that obesity causes a significant accumulation of visceral fat (fat around the abdominal organs) and reduced subcutaneous fat (fat under the skin). This change in the deposition of the fat could affect the way cells use insulin, and, thus, increase the risk of insulin resistance and, eventually, AN (9).
- Hormonal problems: Children with hormonal problems or imbalances may be at a higher risk of developing AN. A few examples of hormonal problems that may increase the risk of AN are hypothyroidism (underactive thyroid gland), polycystic ovary syndrome, and Cushing’s syndrome (1).
Diagnosis Of Acanthosis Nigricans
A doctor can diagnose AN through physical examination of the affected skin. BMI and body weight may be checked to determine if the child is overweight or obese. Blood and urine tests could help determine the underlying cause, such as insulin resistance, hormonal imbalances, etc.
In rare cases, a small sample of the thickened skin (biopsy) may be collected for lab analysis. Parents should inform the doctor about any prescription medications, supplements, vitamins their child is taking before commencing treatment (5).
Treatment For Acanthosis Nigricans In Children
The treatment of AN can be either treating the underlying cause or topical treatments for the dark patches.
Treating the underlying cause
- If your doctor has diagnosed obesity as the cause, then they would prescribe exercises and diet to help your child reduce their weight. If obesity is due to an underlying medical condition, such as hypothyroidism, then medications would be prescribed to control it.
- Medications to keep the blood sugar under control could be prescribed if the child has insulin resistance or type II diabetes.
- Discontinuing medicines that caused AN and prescribing alternative medications could also be advised (10).
- Topical retinoid creams could be used to reduce the pigmentation in the various areas of the skin (consult your doctor if you could apply these in the genital areas).
- Topical vitamin creams, such as vitamin D analog cream, might be helpful in some cases (10).
Once the underlying cause is treated or managed, the dark and thick streaks fade away. Cosmetic treatment methods, such as laser treatment and skin peels, are not recommended for children.
Can You Prevent Acanthosis Nigricans In Children?
Prevention of AN depends on preventing the underlying cause. If your family has a history of obesity or diabetes, then follow these precautions to reduce the child’s risk of insulin resistance and AN.
- Control the intake of sugars and refined flour by your children. Do not let them binge eat candies, muffins, pastries, high-sugar drinks, and processed foods.
- Provide a healthy balanced diet rich in fruits, vegetables, and fiber.
- Encourage your child to exercise daily. You can let them participate in sports or outdoor games.
- Monitor their weight and make sure they are within the prescribed ranges.
If your child has any other condition, such as hypothyroidism, then follow the appropriate treatment prescribed by the doctor.
AN is just a symptom and points towards an underlying problem, like metabolic syndrome, which includes obesity, raised blood pressure, abnormal lipids level and increased cholesterol. Together, this means higher chances of the child to develop diabetes, heart disease and stroke later in their life.
2. TM Nithun, P. S. S Ranugha, Jayadev B Betkerur, Veeranna Shastry; Association of acanthosis Nigricans and insulin resistance in indian children and youth – A HOMA2-IR based cross-sectional study; Indian Dermatology Online Journal
3. Common Terms; American Diabetes Association
4. Skin Complications; American Diabetes Association
5. Hak Yung Ng; Acanthosis nigricans in obese adolescents: prevalence, impact, and management challenges; NCBI
6. Young Kwon Koh, Jae Hee Lee, Eun Young Kim, and Kyung Rye Moon; Acanthosis Nigricans as a Clinical Predictor of Insulin Resistance in Obese Children; Pediatric Gastroenterology Hepatology and Nutrition
7. Meghana Madhukar Phiske; An approach to acanthosis nigricans; Indian Dermatology Online Journal
8. Acanthosis Nigricans; National Organization for Rare Disorders
9. Alan R. Sinaiko, Sonia Caprio; Insulin Resistance; NCBI
10. Nupur U Patel, et al.; Current treatment options for acanthosis nigricans; NCBI
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