Health
| African Americans and a common skin disease: Acanthosis Nigricans (dirty neck) |
| Published Thursday, February 23, 2012 10:00 am |
Acanthosis Nigricans (sometimes called dirty neck) is common skin disorder among African Americans, that has dark brown velvety plaques most commonly found on the skin of the underarms, neck, and knuckles, but can occur on the insides of the thighs and tops of fingers and hands as well.
The discoloration is the result of thickened skin and not an increase in pigment, as is commonly thought by patients. It does not usually have any symptoms, but can occasionally get itchy.
Are there any diseases associated with AN?
AN is associated with many syndromes and diseases, both benign and malignant. Insulin resistance and diabetes mellitus are the most common associations with AN. Other relationships have been shown with malignancy, while even more cases of AN occur without any known underlying disease, except perhaps, obesity. As the prevalence of obesity in adults and children continues to rise, AN becomes an even more important finding to alert physicians of possible pathology and halt disease processes at earlier stages, thus decreasing morbidity and mortality.
Who gets AN?
There is a hereditary type of AN found in young children. There is a type that affects adults with insulin resistance/obesity; if you have diabetes you and your healthcare provider should check your skin regularly. The last type which is rare, typically affects an older population, and is associated with malignancy. AN can affect males and females, but the type that affects adults tends to be more common in women. Regarding race, AN tends to have a higher prevalence among blacks than whites. Native Americans also have been shown to have an increased risk of AN, which correlates with their increased risk of diabetes.
What is the mechanism of AN causing skin lesions?
The darkened skin is not associated with a change or increase in melanocytes (cells that produce melanin, or skin pigmentation), but is due to thickening of the skin layers. As the levels of insulin in the body increase, insulin binds to these receptors on the skin and causes the cells to reproduce and thicken. This results in the thickened, velvety skin seen in AN.
How many different kinds of AN are there?
There are up to eight types of AN, but there are only 4 main types. They are classified as malignancy associated (cancer associated), hereditary, endocrinopathy associated (problems with the endocrine system), and drug-induced. Most cases are idiopathic, which means they have no known cause.
• Type I is rare and is associated with internal malignancy, most often adenocarcinoma.
• Type II AN can be seen at birth or in early childhood. The clinical features tend to worsen during puberty. It is not associated with any increase in cancer risk.
• Type III AN is associated with endocrinopathies. Obesity is highly related, as is insulin resistance and diabetes mellitus. Most cases of AN with a diagnosable underlying condition are related to Type III AN. The highest number of cases of AN are idiopathic (spontaneous or from an unknown cause)…the affected patient may be obese, but a specific disease can not always be diagnosed. Prevalence and severity of insulin resistance is known to be different in different racial groups. Location and severity of AN may relate to severity of insulin resistance. Studies are underway to develop an instrument that scores AN based on all locations, severity and ethnicities, which will be an optimal tool for grading AN.
• Type IV AN is uncommon and is caused by medication. Associated medicines are:
• nicotinic acid
• diethylstilbestrol
• niacinamide
• oral contraceptive pills
• glucocorticoids (oral or intravenous steroids)
How is AN treated?
If there is an underlying disease causing AN, treatment of this disease is necessary. For those who have insulin sensitivity and/or obesity, weight management is ideal. Other options for treatment include topical salicylic creams or lotions available by prescription, ammonium lactate creams or lotions available over-the-counter, or urea-based creams or lotions also available by prescription.
If you think you may have AN, what should you do?
If you think you have AN, it is important to see a physician to determine what type of AN you have. Most physicians are familiar with the diagnosis of AN, but dermatologists are the specialists who see and treat all forms of the disorder most commonly. Checking with your primary physician and working with a dermatologist may be the best approach. Often a combination of topical treatments and weight management are necessary, which will require the participation and commitment of the patient.
Do you need further information or have questions or comments about this article? Please call toll-free 1-877-530-1824. Or, for more information about the Maya Angelou Center for Health Equity please visit our website: http://www.wakehealth.edu/MACHE.
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| Acanthosis Nigricans is dark brown velvety plaques commonly found on the skin of the underarms, neck and knuckles, but can occur on the inside of the thighs and tops of fingers and hands. |
The discoloration is the result of thickened skin and not an increase in pigment, as is commonly thought by patients. It does not usually have any symptoms, but can occasionally get itchy.
Are there any diseases associated with AN?
AN is associated with many syndromes and diseases, both benign and malignant. Insulin resistance and diabetes mellitus are the most common associations with AN. Other relationships have been shown with malignancy, while even more cases of AN occur without any known underlying disease, except perhaps, obesity. As the prevalence of obesity in adults and children continues to rise, AN becomes an even more important finding to alert physicians of possible pathology and halt disease processes at earlier stages, thus decreasing morbidity and mortality.
Who gets AN?
There is a hereditary type of AN found in young children. There is a type that affects adults with insulin resistance/obesity; if you have diabetes you and your healthcare provider should check your skin regularly. The last type which is rare, typically affects an older population, and is associated with malignancy. AN can affect males and females, but the type that affects adults tends to be more common in women. Regarding race, AN tends to have a higher prevalence among blacks than whites. Native Americans also have been shown to have an increased risk of AN, which correlates with their increased risk of diabetes.
What is the mechanism of AN causing skin lesions?
The darkened skin is not associated with a change or increase in melanocytes (cells that produce melanin, or skin pigmentation), but is due to thickening of the skin layers. As the levels of insulin in the body increase, insulin binds to these receptors on the skin and causes the cells to reproduce and thicken. This results in the thickened, velvety skin seen in AN.
How many different kinds of AN are there?
There are up to eight types of AN, but there are only 4 main types. They are classified as malignancy associated (cancer associated), hereditary, endocrinopathy associated (problems with the endocrine system), and drug-induced. Most cases are idiopathic, which means they have no known cause.
• Type I is rare and is associated with internal malignancy, most often adenocarcinoma.
• Type II AN can be seen at birth or in early childhood. The clinical features tend to worsen during puberty. It is not associated with any increase in cancer risk.
• Type III AN is associated with endocrinopathies. Obesity is highly related, as is insulin resistance and diabetes mellitus. Most cases of AN with a diagnosable underlying condition are related to Type III AN. The highest number of cases of AN are idiopathic (spontaneous or from an unknown cause)…the affected patient may be obese, but a specific disease can not always be diagnosed. Prevalence and severity of insulin resistance is known to be different in different racial groups. Location and severity of AN may relate to severity of insulin resistance. Studies are underway to develop an instrument that scores AN based on all locations, severity and ethnicities, which will be an optimal tool for grading AN.
• Type IV AN is uncommon and is caused by medication. Associated medicines are:
• nicotinic acid
• diethylstilbestrol
• niacinamide
• oral contraceptive pills
• glucocorticoids (oral or intravenous steroids)
How is AN treated?
If there is an underlying disease causing AN, treatment of this disease is necessary. For those who have insulin sensitivity and/or obesity, weight management is ideal. Other options for treatment include topical salicylic creams or lotions available by prescription, ammonium lactate creams or lotions available over-the-counter, or urea-based creams or lotions also available by prescription.
If you think you may have AN, what should you do?
If you think you have AN, it is important to see a physician to determine what type of AN you have. Most physicians are familiar with the diagnosis of AN, but dermatologists are the specialists who see and treat all forms of the disorder most commonly. Checking with your primary physician and working with a dermatologist may be the best approach. Often a combination of topical treatments and weight management are necessary, which will require the participation and commitment of the patient.
Do you need further information or have questions or comments about this article? Please call toll-free 1-877-530-1824. Or, for more information about the Maya Angelou Center for Health Equity please visit our website: http://www.wakehealth.edu/MACHE.
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