From the Guidelines
The treatment for an 8-year-old child with elevated liver enzymes and acanthosis nigricans around the neck is intensive lifestyle modification.
Key Recommendations
- Lifestyle modification is the first line of treatment for children with non-alcoholic fatty liver disease (NAFLD) as it improves aminotransferases and liver histology 1.
- Metformin should not be prescribed to children with NAFLD as it offers no benefit at a dose of 500 mg twice daily, and the effect of higher doses is unknown 1.
- Vitamin E may offer histological benefits to children with biopsy-proven non-alcoholic steatohepatitis (NASH) or borderline NASH, but confirmatory studies are needed before its use can be recommended in clinical practice 1.
Diagnostic Approach
- The presence of acanthosis nigricans around the neck in an overweight or obese child suggests insulin resistance, which is a risk factor for NAFLD 1.
- Abdominal ultrasound and liver function tests should be the first diagnostic step in suspected NAFLD children, followed by exclusion of other liver diseases 1.
- Liver biopsy may be considered to rule out other treatable diseases, in cases of clinically suspected advanced liver disease, or as part of a structured intervention protocol or clinical research trial 1.
From the Research
Treatment for Elevated Liver Enzymes and Acanthosis Nigricans
- The treatment for an 8-year-old child with elevated liver enzymes and acanthosis nigricans around the neck may involve addressing the underlying cause of the condition, such as obesity or insulin resistance 2, 3.
- Weight reduction and treatment of underlying endocrinopathy may be considered as part of the treatment plan 2.
- Topical retinoids, vitamin D analogs, chemical peels, and other keratolytics may be used to treat localized lesions of acanthosis nigricans 2.
- In some cases, systemic therapy such as oral retinoids may be considered for extensive or generalized acanthosis nigricans 2.
Association with Metabolic Risk Factors
- Clustering of metabolic risk factors, such as excess body fat, has been associated with high-normal levels of liver enzymes, including alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) 4.
- Acanthosis nigricans has been linked to insulin resistance and an increased risk of developing type 2 diabetes mellitus and metabolic syndrome 3, 5.
- The presence of acanthosis nigricans in children and adolescents may be a useful clinical marker for identifying those at risk of developing cardiometabolic disorders 5.
Monitoring and Treatment of Liver Enzyme Abnormalities
- Elevated liver enzymes are not uncommon in children receiving certain medications, such as those used to treat tuberculosis 6.
- Monitoring of liver function tests, including ALT and GGT, may be necessary in children with elevated liver enzymes or those at risk of developing liver enzyme abnormalities 6, 4.