Acanthosis Nigricans: History taking

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Acanthosis Nigricans: History taking

Acanthosis nigricans of the neck
  • Management of patients with acanthosis nigricans depends
    on the underlying cause.
  • Most cases are idiopathic and associated with obesity (pseudo–acanthosis nigricans).
  • Most patients with AN have either clinical or subclinical insulin resistance.
  • Generalized AN is very rare, and seen only in children.

Ask about :

  • Age of onset?
    • Since birth or during early childhood and associated with skeletal abnormalities and/or short stature : Consider syndromes like :
      • Crouzon syndrome.
      • Costello syndrome.
      • Rabson-Mendenhall syndrome.
      • Beare-Stevenson cutis gyrata syndrome.
      • etc
    • Early childhood : exclude familial type.
    • Over 40 years of age with no hx of endocrine problems, exclude malignant type.
    • Childhood or adolescence and associated with loss of subcutaneous fat: consider generalized or partial lipodystrophy.
  • Abrupt onset
    • Suspect malignant type.
  • Family history?
    • Familial acanthosis nigricans: a rare autosomal dominant condition.
    • Begins during early childhood but may manifest at any age.
    • Stabilize or regress after puberty.
  • History of Drugs?(Drug-induced AN)
    • Nicotinic acid.
    • Insulin.
    • Pituitary extract.
    • Systemic corticosteroids.
    • Diethylstilbestrol.
    • Triazinate.
    • Oral contraceptives.
    • Fusidic acid.
    • Methyltestosterone.
  • Obesity: obesity-associated acanthosis nigricans
    • Search for Diabetes and other underlying endocrinopathies.
  • Hyperandrogenism  manifestations: Syndromic acanthosis nigricans
    • Hirsutism, acne vulgaris, hidradenitis suppurativa, Irregular menstrual periods, and androgenic alopecia: exclude HAIR IN Syndrome and Polycystic ovary syndrome in female patients.
  • Cushing syndrome manifestations:
    • Striae
    • Hypertension
    • Central obesity
    • Buffalo hump
  • Autoimmune disease
    • Acanthosis nigricans may associated with autoimmune disorders like SLE, Sjogren’s syndrome, scleroderma or Hashimoto’s thyroiditis.
  • Malignant acanthosis nigricans
    • Age of onset? mostly old age.
    • Severe and extensive
    • Mucous membrane involvement and thickening of the palms and soles.
    • Itching
    • Search for ( Leser–Trélat sign – Tripe palms): suggestive of malignancy.
    • Weight loss.
    • The most common is gastric carcinoma (ask about gastric manifestations e.g. heartburn) followed by pancreatic cancer, gynecological malignancies, and lung carcinoma.
    • It may occur with, before or after the onset of internal malignancy.
    • It has been detected in children with Wilms tumors and osteogenic sarcomas.
    • Refer to an appropriate specialist.
  • Site of affection
    • dorsal hands and feet : Acral type
    • Axilla
    • The neck
    • Scalp
    • Face
    • Abdomen
    • Chest
    • Areola
    • Groin
    • Extensor surfaces.
    • Mucous membranes
  • Unilateral or bilateral
    • Unilateral: Nevoid Acanthosis nigricans.

References


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