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Acanthosis nigricans in Child
See also in: Anogenital
Other Resources UpToDate PubMed

Acanthosis nigricans in Child

See also in: Anogenital
Contributors: Kyle Cheng MD, Belinda Tan MD, PhD, Oyetewa Oyerinde MD, Callyn Iwuala MD, Susan Burgin MD
Other Resources UpToDate PubMed


Acanthosis nigricans (AN) is a localized skin disorder typically characterized by symmetric hyperpigmented velvety plaques in skin folds. It is due to overstimulation of fibroblasts and keratinocytes via insulin-like growth factor receptors and tyrosine kinase receptors. AN is most commonly associated with obesity and is a marker of insulin resistance. A 2007 study found that up to 90% of youth with AN also carried a diagnosis of diabetes mellitus.

AN is classified into 8 types:

I. Obesity-associated – Most common; linked to diabetes, insulin resistance, high body mass index (BMI), metabolic syndrome, etc.

II. Malignancy-associated / cutaneous paraneoplastic syndrome – Very rare in children, but has been documented with juvenile gastric adenocarcinoma (most common), Wilms tumor, and osteogenic sarcomas.

III. Drug-induced – Niacin (nicotinic acid) is the most closely associated medication, but AN can also be caused by oral contraceptives, corticosteroids, diethylstilbestrol, heroin, fusidic acid, methyltestosterone, protease inhibitors, and folate.

IV. Syndromic – Related to a specific syndrome, eg, HAIR-AN (hyperandrogenism, insulin resistance, and acanthosis nigricans) syndrome, polycystic ovarian syndrome, or autoimmune-disease, among others.

V. Acral – Affects elbows, knees, and knuckles. Typically seen in healthy sub-Saharan African patients.

VI. Unilateral – Also called nevoid. Usually represents an epidermal nevus in childhood.

VII. Benign – Rare autosomal dominant form developing at birth or during childhood. Typically stabilizes or regresses during puberty.

VIII. Mixed – Any 2 or more of the above types combined.


L83 – Acanthosis nigricans

402599005 – Acanthosis nigricans

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Confluent and reticulated papillomatosis (CARP)
  • Terra firma-forme dermatosis – Can be removed by rubbing with isopropyl alcohol.
  • Crouzon syndrome
  • Reticulate pigmented anomaly of flexures
  • Granular parakeratosis
  • Ashy dermatosis
  • Bullous congenital ichthyosiform erythroderma

Best Tests

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Management Pearls

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated:10/23/2018
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Patient Information for Acanthosis nigricans in Child
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Acanthosis nigricans in Child
See also in: Anogenital
A medical illustration showing key findings of Acanthosis nigricans : Axilla, Hyperpigmented patch, Neck
Clinical image of Acanthosis nigricans - imageId=40959. Click to open in gallery.  caption: 'Acanthotic, thickened, ridged, and hyperpigmented plaques on the posterior neck.'
Acanthotic, thickened, ridged, and hyperpigmented plaques on the posterior neck.
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