From the Guidelines
Topical retinoids, such as tretinoin 0.025-0.1% cream or adapalene 0.1% gel, are the most effective treatment for acanthosis nigricans, as they accelerate skin cell turnover and normalize keratinization, reducing the thickened, darkened skin characteristic of the condition 1. When using topical retinoids for acanthosis nigricans, it is essential to follow a gentle skincare routine to minimize irritation.
- Apply a pea-sized amount to affected areas once daily, preferably at bedtime, after gently cleansing the skin.
- Start with the lower strength and use every other night for the first 2-3 weeks to minimize irritation, then gradually increase to nightly use as tolerated.
- Treatment should continue for at least 3-6 months to see significant improvement.
- Combine with a gentle moisturizer applied 20-30 minutes after the retinoid to reduce dryness.
- Sun protection is essential during treatment as retinoids increase sun sensitivity. The mechanism of action of topical retinoids involves accelerating skin cell turnover and normalizing keratinization, which helps reduce the thickened, darkened skin characteristic of acanthosis nigricans 1. They also inhibit melanin transfer to keratinocytes, gradually lightening hyperpigmentation. For optimal results, it is crucial to address any underlying conditions like insulin resistance or obesity, as these are common triggers for acanthosis nigricans 1. If skin irritation becomes severe, temporarily reduce the frequency of application until the skin adjusts.
From the Research
Treatment Options for Acanthosis Nigricans
- Acanthosis nigricans is a skin disorder characterized by hyperpigmented and velvety plaques, and various treatment options are available, including topical retinoids, vitamin D analogs, and keratolytics 2, 3, 4.
- Topical retinoids are considered a first-line therapy for treating hyperpigmented plaques, but skin irritation can be a limiting factor 2.
- Combinational therapies have been developed to combat skin irritation and are being used to treat acanthosis nigricans 2.
Efficacy of Retinoids in Treating Acanthosis Nigricans
- Studies have shown that topical retinoids, such as 0.025% and 0.05% tretinoin creams, are efficacious in treating acanthosis nigricans, with improvements in skin hyperpigmentation and erythema indices 5, 6.
- The efficacy of 0.025% and 0.05% tretinoin creams has been compared, and both concentrations have been found to be well-tolerated with similar efficacy and safety profiles 5.
- A study comparing 10% urea cream and 0.025% tretinoin cream found that 0.025% tretinoin was significantly more effective in treating acanthosis nigricans 6.
Management and Treatment Strategies
- Management of acanthosis nigricans involves general measures, such as weight reduction and addressing underlying causes, as well as topical and oral medications, chemical peels, and laser therapy 3, 4.
- Early recognition of acanthosis nigricans is important, as it can be a cutaneous manifestation of systemic disorders or internal malignancy, and treatment should focus on addressing the underlying cause 4.
- Topical retinoids, vitamin D analogs, and keratolytics are often used to treat localized lesions, while systemic therapy, such as oral retinoids, may be considered for extensive or generalized acanthosis nigricans 4.