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Acanthosis Nigricans and PCOS: the cause of dark skin patches

Acanthosis nigricans is a skin condition commonly characterised by dark, velvety patches in body folds and creases. If you’ve noticed these changes on your skin, it could be a manifestation of an underlying health issue, such as polycystic ovary syndrome also known as polycystic ovarian syndrome (PCOS). The link between acanthosis nigricans and PCOS highlights the importance of recognising these skin changes as potential indicators of broader health concerns.

Identifying acanthosis nigricans is key in prompting further investigation into your overall health, particularly regarding metabolic conditions. A proper diagnosis of this skin condition can often lead to the discovery of PCOS, allowing you to address the skin’s appearance and associated health risks. By understanding how acanthosis nigricans and PCOS are connected, you can take the necessary steps towards effective treatment and management.

Key Takeaways

  • Acanthosis nigricans is a skin symptom that may signal underlying conditions like PCOS.
  • PCOS is associated with other skin problems such as acne, oily skin and skin tags.
  • Recognising acanthosis nigricans can lead to timely diagnosis and treatment.
  • Managing acanthosis nigricans involves addressing the association with insulin resistance.

What is Acanthosis Nigricans?

Acanthosis nigricans is a skin condition characterised by hyperpigmentation and hyperkeratosis, resulting in dark, velvety lesions, especially in body creases. Your skin may undergo changes, displaying a unique texture and appearance. Commonly affected areas include the neck, axillae (armpits), groin, and other skin creases, plus wherever skin rubs together, like underarms or behind knees.

These dark skin patches can be a sign that your body may have insulin resistance, which is frequently associated with conditions like polycystic ovary syndrome (PCOS). Acanthosis nigricans can affect anyone and is not directly caused by weight.

Through a proper understanding of acanthosis nigricans, you can seek appropriate medical advice if you notice such changes in your skin, ensuring early detection of underlying conditions. It’s important to treat the skin gently, avoiding harsh treatments that can aggravate the condition.

Causes and Risk Factors

Skin conditions such as acanthosis nigricans (AN) in the context of polycystic ovary syndrome (PCOS) have multiple potential causes and risk factors. The primary factor often cited is insulin resistance, which your body may experience due to PCOS or other conditions such as Type 2 diabetes. When your body is resistant to insulin, it can lead to higher levels of this hormone, known as hyperinsulinemia, which in turn can stimulate skin cells to proliferate abnormally, leading to the characteristic dark patches of skin. These hormonal imbalances are linked to other symptoms of PCOS including excess weight gain, hair loss, irregular periods, excess hair growth, adult acne and more.

Although the exact cause of AN is unknown, there are several potential causes:

  • Genetics: You might have a hereditary predisposition, meaning that if there is a family history of PCOS or AN, you might be at an increased risk.
  • Medications: The use of certain medicines, notably steroids and corticosteroids, can contribute to the development of AN.
  • Metabolic Concerns: Being part of a metabolic syndrome, AN alongside PCOS suggests your metabolic health requires attention. Conditions associated with metabolic syndrome include glucose abnormalities and increased insulin levels.

Hyperandrogenism, insulin resistance and acanthosis nigricans are considered a specific PCOS subphenotype. This subphenotype is seen in almost 5% of all people with hyperandrogenism.

In rarer instances, AN can be a marker of an internal malignancy, typically known as malignant acanthosis nigricans. This is more commonly associated with gastric adenocarcinoma or other internal cancers, although it’s less common in those with PCOS.

It’s important to note that while AN is associated with PCOS and other metabolic disorders, the presence of these darkened skin patches does not confirm the presence of these conditions, but it warrants further investigation to identify the underlying cause and manage your health effectively.

Acanthosis Nigricans and PCOS

Acanthosis nigricans is a skin condition often associated with polycystic ovary syndrome (PCOS). It is characterised by darkened, velvety patches of skin, most commonly found in body folds. When you have PCOS, the likelihood of developing acanthosis nigricans increases due to insulin resistance, a common feature of PCOS. Insulin resistance is the body’s diminished ability to respond to insulin, often leading to hyperinsulinemia. Hyperinsulinemia is the excess levels of insulin in the blood, stimulating the production of insulin-like growth factor which can prompt skin changes.

Your management plan might include lifestyle changes aimed at reducing insulin resistance and improving insulin sensitivity. Embracing a weight-inclusive approach, focusing on your overall health and well-being, can be beneficial. This may include making nutrition changes using the Intuitive Eating framework.

Diagnosis of Acanthosis Nigricans

If you notice skin changes that resemble acanthosis nigricans, it’s important to consult a dermatologist for an accurate diagnosis. These skin changes often appear as dark, velvety skin patches in body folds and creases.

A dermatologist will examine your skin to determine if the changes are characteristic of acanthosis nigricans associated with PCOS. Diagnostic steps typically involve a thorough skin examination, a review of your medical history, an assessment of any symptoms plus possible further laboratory tests to rule out other conditions.

Here are some aspects of the diagnostic workup:

StepPurpose
Visual InspectionTo identify distinctive skin patches
Medical HistoryTo evaluate associated risk factors
Blood TestsTo check insulin levels
Skin BiopsyRarely needed to confirm a diagnosis

Remember, acanthosis nigricans itself is not harmful, but it can be a sign of an underlying issue, such as PCOS, that may require further attention and management. Your dermatologist might also investigate whether insulin resistance is present, which is a common condition in people with PCOS. This usually involves measuring blood sugar levels and insulin through a series of tests.

Early diagnosis and intervention can help manage the symptoms and improve the skin’s appearance, as well as address any associated health issues. Stay informed about your health and don’t hesitate to seek a professional opinion if you have concerns.

Treatment and Management

Acanthosis nigricans (AN), often linked with polycystic ovary syndrome (PCOS), can be distressing. Your treatment should aim at managing underlying conditions such as insulin resistance, while also directly addressing skin changes. Effective management frequently involves a multifaceted approach including lifestyle modifications, pharmaceutical options, and in some cases, procedural interventions. Here are some of the most common treatment options for AN.

Nutrition and Lifestyle Changes

Embarking on nutrition tweaks and changes may reduce the likelihood of AN associated with PCOS. Focusing on creating meals and snacks that contain all three macronutrients i.e. fats, proteins and carbohydrates, can help with blood glucose balance. You can also increase your fibre intake to help with blood glucose management. Increased physical activity can improve insulin sensitivity and diminish skin lesions. It is important to focus on long-term, sustainable habits rather than short-term diets.

Medications and Drugs

Physicians may prescribe medications and drugs to target insulin resistance and indirectly improve AN symptoms. Metformin, a prominent treatment option, may be helpful in regulating insulin levels. Inositol, an insulin sensitiser, is a popular alternative to Metformin and has a reduced likelihood of causing health problems like gut issues. Other drugs, like rosiglitazone and niacin, might be beneficial as well but require medical oversight due to potential side effects.

Topical Treatments

Topical treatments, including tretinoinretinoidsnicotinic acid, and calcipotriol, can be applied directly to the affected areas. They work by exfoliating the skin and promoting cellular turnover, which may lighten the dark patches characteristic of AN. Your dermatologist can prescribe topical treatments.

Procedural Interventions

When topical treatments are insufficient, procedural interventions such as laser therapy with an alexandrite laser, chemical peels using glycolic acid or trichloroacetic acid, and dermabrasion might be recommended. These procedures aim to remove the outer layers of skin, which can help lighten the affected areas. Nonetheless, they should be carried out by skilled professionals to minimise side effects.

Frequently Asked Questions

If you’re seeking information about managing acanthosis nigricans linked with PCOS, the following commonly asked questions cover effective treatments, management techniques, and more, tailored to your concerns.

What treatments are effective for acanthosis nigricans associated with PCOS?

For treating acanthosis nigricans connected with PCOS, addressing insulin resistance is key. Medications such as metformin may help improve insulin sensitivity and subsequently reduce the darkening of the skin when combined with dietary changes and physical activity.

Are there any topical creams that successfully treat acanthosis nigricans?

Topical creams containing retinoids or exfoliants like alpha hydroxy acids may help lighten the affected skin. However, their efficacy varies, and they are most effective when part of a comprehensive treatment plan under medical supervision.

Is skin darkening a common symptom of PCOS?

Skin darkening, especially in skin folds and areas such as the neck and armpits, can be a common symptom of PCOS, often resulting from insulin resistance which is a frequent underlying issue in PCOS.

What causes acanthosis nigricans to develop in the under-breast area?

Acanthosis nigricans develops in the under-breast area and other skin folds due to insulin spillover from the bloodstream into the skin, which then triggers an overgrowth of skin cells, leading to the characteristic dark, velvety patches.

What areas of the body do acanthosis nigricans develop?

Acanthosis nigricans typically develop in skin folds: the neck, armpits, under the breasts, groin, and sometimes in other creases of the skin such as the elbows, knees, and knuckles.

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Alex Okell ANutr Founder and Editor

Founder and Editor | Registered Associate Nutritionist

  Founder of Be The Collective LTD [The PCOS Collective & The Endo Collective] Alex Okell ANutr is a London-based reproductive health nutritionist with experience in research, private practice and digital media. She holds a Master’s degree in Nutrition from King’s College London and has co-authored papers with the University of Cambridge, King’s College London, The Food Foundation and the Food Standards Agency. Alex offers 1:1 PCOS support in our virtual PCOS clinic.

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