Acanthosis nigricans

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Acanthosis nigricans are brown to black, undefined, and velvety hyperpigmentation. Usually found in body folds, such as the posterior and lateral folds of the neck, armpits, groin, navel, forehead, and other areas.

Video Acanthosis nigricans

Classification

Acanthosis nigricans are conventionally divided into benign and malignant forms, although can be divided into syndromes according to the cause:

• Benign This may include those associated with obesity, heredity, and endocrine form of acanthosis nigricans.
• Malignant. This may include forms associated with tumor products and activities such as insulin, or tumor necrosis factor.

An alternative classification system is still used to describe the acanthosis nigricans proposed in 1994. It describes acanthosis nigricans syndrome according to their associated syndromes, including benign and malignant forms, forms associated with obesity and drugs, acralosis acanthosis nigricans, unilateral acanthosis nigricans , and syndromic mixtures and forms.

Maps Acanthosis nigricans

Signs and symptoms

Acanthosis nigricans can present with thickened skin, velvety, relatively darker areas of the neck, armpits and skin folds.

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Cause

This usually occurs in individuals younger than age 40, may be genetically inherited, and is associated with obesity or endocrineopathy, such as hypothyroidism, acromegaly, polycystic ovarian disease, insulin resistant diabetes, or Cushing's disease.

Type I - familial

Acanthosis keluarga mungkin timbul sebagai akibat dari sifat dominan autosomal, yang muncul saat lahir atau berkembang selama masa kanak-kanak.

Tipe II - endokrin

The endocrine syndrome associated with acanthosis nigricans can develop in many conditions, especially:

• begins with insulin resistance, such as diabetes mellitus and metabolic syndrome
• excess androgen circulation, especially Cushing's disease, acromegaly, polycystic ovarian disease
• Addison's disease and hypothyroidism
Rare diseases, including pinealoma, leprechaunism, lipoatrophic diabetes, pineal hyperplasia syndrome, pituitary basophilism, ovarian hypertrophy, stromal luteoma, ovarian dermoid cysts, Prader-Willi syndrome, and Alstrom syndrome.

Acanthosis nigricans associated with endocrine dysfunction are more dangerous in its onset, less spread, and patients are often obese at the same time.

Type III - obesity and pseudoacanthosis nigricans

In young people, acanthosis nigricans is a visible marker that strongly indicates insulin resistance. Higher insulin levels than normal in the bloodstream cause dark skin growth in certain areas of the body. No skin care will get rid of AN. Acanthosis nigricans can alleviate and possibly disappear by treating the root cause, insulin resistance, but it can take months or years to do so. Insulin resistance syndrome can be divided into type A syndrome (HAIR-AN) and type B. Most cases of acanthosis nigricans are associated with obesity and are otherwise idiopathic. This may be due to insulin resistance, and more likely to occur in dark-skinned people. It can also be referred to as pseudoacanthosis nigricans.

Type IV - drug-related

Acanthosis nigricans have been associated with the use of nicotinic acid, the use of glucocorticoids, combined oral contraceptive pills, and growth hormone therapy.

Type V - malignancy

Malignant acidosis of malignant nigricans refers to acanthosis nigricans occur as paraneoplastic syndrome associated with cancer. Acanthosis Malignant nigricans are most commonly associated with gastrointestinal adenocarcinoma, as well as genitourinary cancers such as those of the prostate, breast, and ovary. Other cancers, such as lung, stomach, and lymphoma, are sometimes associated with acanthosis nigricans.

This form of acanthosis nigricans is more likely to involve the mucous membranes (25-50% of cases). Malignant nigric acidosis may precede (18%), accompany (60%), or follow (22%) of onset of internal cancer. Acidosis associated with malignant nigricans is usually rapidly onset and may be accompanied by skin tags, multiple seborrhoeic keratosis, or palate of the palms.

Acan acanthotic anomaly

Acral acanthotic anomaly refers to a variant of acanthosis nigricans confined to the elbows, knees, knuckles, and dorsal foot surfaces, in the absence of other findings, in healthy individuals. While etiology is still unknown, its presence does not indicate the possibility of malignancy.

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Pathophysiology

The pathogenesis of acanthosis nigricans is poorly understood, and tends to correlate with interacting factors, including activation of insulin-mediated ILGF receptors on keratinocytes, and increased levels of growth factors.

Factors involved in the development of acanthosis nigricans include:

• Increased circulating insulin. This activates ILGF keratinocyte receptor, especially IGF-1. At high concentrations, insulin can also replace IGF-1 from IGFBP. Increased circulating IGF may lead to keratinocyte and dermal proliferation of fibroblasts.
• Fibroblast growth factor. The hereditary variant is associated with FGFR defects.
• Increased TGF, which seems to be a mechanism for malignant acanthosis associated with malignancy. TGF acts on epidermal tissue via EGFR.

In conjunction with elevated levels of ILGF end, there is a possibility that sweat and friction may require predeterminants for lesions.

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Diagnosis

Acanthosis nigricans are usually diagnosed clinically. Skin biopsy may be necessary in unusual cases. If there is no obvious cause, it may be necessary to look for one. Blood tests, endoscopy, or X-rays may be needed to eliminate the possibility of diabetes or cancer as the cause.

On biopsy, hyperkeratosis, epidermal folds, leukocyte infiltration, and melanocyte proliferation can be seen.

Differential diagnosis

Acanthosis nigricans should be distinguished from the casal collar that appears on pellagra.

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Treatment

People with acanthosis nigricans should be screened for diabetes and, rarely, cancer. Controlling blood glucose levels through exercise and diet often improve symptoms. Topical fade creams (usually used to remove age spots) can brighten the skin cosmetically in less severe cases. Acanthosis nigricans maligna can be cured if the cause tumor is successfully removed.

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Prognosis

Acanthosis nigricans tend to improve in circumstances where known causes are removed. For example, acanthosis nigricans associated with obesity will increase with weight loss, and drug-induced acanthosis nigricans may disappear when the drug stops. The hereditary variant may or may not fade with age, and the variant associated malignancy may, after malignancy is removed, fades.

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References

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External links

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Source of the article : Wikipedia