Dark Neck? It Could Be Acanthosis Nigricans | Dermatologist Explains

[00:00:00]Well, hey guys. Welcome back. If you're new here, I'm Dr. Dre. I'm a boardcertified dermatologist. If you have ever noticed these thick, velvety, rough areas of what looks like dirty skin on the back of your neck, under your arms, in the skin folds, even the sides of your face, this is actually a condition known as aanthosis, nigricans.

[00:00:18]It has nothing to do with hygiene.

[00:00:19]Today, we're going to talk about this condition, why it's an important warning sign of potential underlying health problems. I'm going to talk about treatments and stay tuned to the end because I'm also going to be discussing a never-before discussed on my channel emerging therapy that actually can work to get rid of aanthosis nigricans.

[00:00:37]Aanthosis nigricans isn't simply hyperpigmentation. It's actually a type of skin thickening. It's related to overexpression of insulin leads to hyperp proliferation and thickening of the epidermis. In other words, it's an overgrowth of the outer layer of the skin leading to the appearance of dark discoloration. But it's not actually true hyperpigmentation. It's not melanin. In other words, pigment lightening ingredients like hydroquinone are not going to address this. It's due to skin thickening, not to excessive pigment production, per se. The most common location is the back of the neck, the sides of the face, under the arms, really anywhere where you have skin folds. It also can appear on the backs of the hands over the knuckles. Here's the most interesting thing about aanthosis niger cans and why you should never ignore it. First of all, it has nothing to do with your hygiene. It's not dirt, it's skin thickening. But it's an important warning sign of hyperinsulinemia, excessive insulin. In other words, it's actually a very important warning sign that you could be developing what's known as insulin resistance, which leads to diabetes.

[00:01:43]Elevated insulin doesn't just affect your blood sugar. It can stimulate growth signals that affect all sorts of things including your skin. High insulin levels activate something known as insulin like growth factor. This binds to insulin like growth factor receptors in the skin and leads to hyperp proliferation of the keratinoicides which are the cells that make up your epidermis. As a side note, it's also thought that elevated insulin may likewise play a role in the formation of acrocordons, otherwise known as skin tags, which if you deal with those as well, make sure you check out my content on this channel with regard to how to get rid of skin tags, why they happen, and all of the treatments to get rid of them. Recent research also points to the role of overactivity of a particular pathway known as mTor. This pathway is important for regulating cell growth and protein synthesis. When mTor activity is upregulated well that leads to hyperp proliferation of cells like keratinocytes causes them to mature excessively and this contributes to that thick dark discolored appearance that the skin assumes. For this reason, dermatologists have recently explored therapeutics that specifically target the mTor signaling pathway in an effort to improve aanthosis nigricans. For example, the topical medication cerolymus. Anyone can get aanthosis nigraans. However, it's especially common amongst people who have obesity and insulin resistance. It's also a lot more common in individuals with deeper skin tones, though it can occur in anyone. Some studies suggest that nearly one in five adults in the United States has echanthosis nigraans and the condition disproportionately affects communities where you have deeper skin tones. It's estimated that millions of people worldwide deal with this. So it's not some rare American disease. Beyond the skin changes themselves. Though this skin condition, like many skin conditions, can take a toll on one's mental health. Many people report feeling embarrassed, lowered self-esteem and self-confidence, anxiety, taking great lengths to avoid certain clothing styles in an effort to hide the aanthosis nigricans. Although insulin resistance is the most common underlying condition leading to aanthosis nigricans, it's not in of itself the only thing. It's commonly seen in people who have PCOS and existing diabetes, patients with the metabolic syndrome and or obesity. Likewise, these are groups where diabetes is a lot more likely.

[00:04:05]insulin resistance is a lot more likely.

[00:04:08]But in some circumstances, certain medications can actually drive this condition as well. Systemic corticosteroids like prennazone, oral contraceptive pills, testosterone, insulin, and some other medications that are less commonly used. There are also rare inherited or genetic syndromes that have athosis nigricans as a manifestation. Autoimmune disorders sometimes can be associated with this and very very rarely certain underlying cancers especially stomach cancer and other gastrointestinal cancers. But I want to emphasize this cancer associated aanthosis nercans is very very rare. Far and away the most common associated underlying health problem is insulin resistance usually in the setting of obesity maybe PCOS metabolic syndrome and heralding potential or existing diabetes. In contrast, however, if it is associated with an underlying cancer, it's a lot more sudden in its onset and very striking and a lot more widespread.

[00:05:08]Not just the back of the neck appearing gradually over time, but rather sudden explosive diffuse aanthosis nigricans over wide body surface areas. Plus in contrast to the typical presentation of aanthosis nigric cancer when it is associated with an underlying cancer typically the patients will have loss of appetite weight loss generalized fatigue and they will clearly not be at their baseline health. In other words, when the history and presentation doesn't quite fit the typical garden variety aanthosis nigricans presentation, further investigation is warranted to look for and rule out an underlying malignancy. Aanthosis nigricans is a diagnosis that for the most part is made clinically. Meaning the dermatologist walks into the room and you show them the problem and they look at it and they also usually look at the rest of your skin looking for other signs of aanthosis nerans at other body locations that you may not be aware of and any other potentially corroborating findings like I already mentioned perhaps skin tags as well. Your dermatologist likely will inquire about your weight, your family history, medications that you're taking, and for women, their menstrual history. Do you have regular periods or are they irregular? Have you had difficulty trying to conceive? Any symptoms of other hormone disorders, rapid weight loss? Of course, aanthosis hands is usually most bothersome to the patient because of how it appears. But it's also very important not to ignore the association with insulin resistance and therefore the dermatologist likely will pursue an underlying metabolic workup, checking things like a fasting blood sugar. The American Diabetes Association recommends screening for diabetes and other associated metabolic conditions in the setting of athosis nigricans where appropriate. All right, but you're probably here cuz you maybe realize you already have this and you want to know how to get rid of it. Like what can be done to remove this once and for all?

[00:07:01]Well, first and foremost, the most pressing thing when it comes to managing aanthosis nigricans is addressing and controlling the underlying insulin resistance. Because if you don't check that and get it under control, well, the aanthosis nigricans not only cannot improve, but it will continue to gradually worsen. Not to mention, your health will decline. Insulin resistance can drastically improve through weight management, lifestyle changes, dietary modifications and if diabetes is present, treating that all of these things together can result in actually improvement of if not just frank stabilization of aanthosis nigraans.

[00:07:36]Although unfortunately the skin may not return to completely normal, meaning it might never totally completely go away even when the underlying insulin resistance is well controlled. Although again that is like the most important thing. Sometimes topical treatments can be tried with varying levels of success.

[00:07:53]It wouldn't be dermatology without us trying a topical retinoid. Yes, tininoan can definitely improve the appearance of aanthosis nan, reduce the skin thickening, soften the skin and make it look a lot less obvious. And chemical exfoliants like glycolic acid, lactic acid, salicylic acid can soften and smooth the skin surface diminishing the appearance of aanthosis nyroans. These acids can be used at very high strength and inoff chemical peels for perhaps even more impressive results. There's a medication called calcitriene which we use to treat psoriasis another skin condition where you have hyperp proliferation going on in the epidermis though a bit different than aanthosis nyans and that likewise can help quite a bit and then you have a variety of resurfacing laser treatments that can smooth the surface of the skin and substantially improve the appearance of aanthosis nigraans. One of the greatest challenges though is that many of these techniques, treatments, topicals in particular such as retinoids, glycolic acid, lactic acid, they can be very irritating when applied to the skin folds. For example, if you have this under the arms, glycolic acid, it can be pretty irritating under the arms. Some people don't tolerate that whatsoever, limiting use and success with treatment.

[00:09:08]Overall, the most bang that you're going to get from your buck from these is really just an improvement in skin texture and smoothness. But they do not like completely erase the aanthosis nigricans for the most part. As of today, there is absolutely no established FDA approved treatment for aanthosis nigricans. Like there is not a medication whose indication is aanthosis nigraans. So, this brings us to a very interesting new study which I'm very excited to tell you guys about because I'm really optimistic about this therapeutic and it's definitely worth knowing about if this is something you have struggled with perhaps bringing up to your dermatologist if they are interested in maybe experimenting with it honestly. So, researchers recently evaluated topical serimmus gel 0.2%.

[00:09:56]This is an FDA approved topical medication for a skin condition known as an angio fibram. A totally unrelated skin bump. We'll say for the purposes of today's video and keeping it brief. The rationale here is biologically compelling. Rather than simply exfoliating, softening, smoothing, helping to normalize to a certain extent epidermal maturation. This has a much different mechanism of action because serillymus inhibits the mtor pathway.

[00:10:23]And again, it's the mTor pathway whose overactivation is thought to play a key role in stimulating the proliferation of the keratinocytes and the overgrowth of the skin that results in aanthosis nigroans. So in a small 12-week pilot study of five adults with aanthosis nigricans, specifically on the back of the neck who had not used any treatments to that area in the preceding 30 days.

[00:10:46]They applied the serimma 0.2% 2% gel twice a day to the back of the neck for the 12 weeks of the study. By the end of the study, the researchers detected a 20% reduction in overall pigmentation of the affected areas using very specific tests for the overall appearance of the skin lesions. Not just, oh yeah, it looks lighter to the eyes. They also saw an overall 30% improvement in the combination of both pigmentation as well as skin texture. And these improvements were noticeable as early as 4 weeks. As I've said before, no skin treatment pretty much works overnight. There are a few exceptions, of course, but for the most part, skin care, skincare ingredients, topical medications, they take time to work. So, knowing that, you might start to see benefits in 4 weeks, that's really encouraging. If it were, oh, it's going to take 12 weeks to see any difference. Some people they don't persist that long because they want more rapid results and they become impatient and bail. Patients had quite a high level of treatment satisfaction as well.

[00:11:48]Again, if patients are not satisfied, they tend to not stick with things and then they never work. Importantly, quality of life scores improved. Many participants noted that their skin no longer negatively impacted their day-to-day lives. That's huge. Even if it didn't change the appearance at all, people feel better, feel better about themselves using it. That is a win. What were the side effects? Only mild temporary irritation of the skin where it was applied. Namely, just some dryness and redness at the application site. As exciting as this all sounds, it's important to put it into perspective. These results are exciting, but they need to be interpreted carefully. This was a very small pilot study, just five participants. There was no placebo control. There was no comparison treatment cuz again there's no standard of care. There's no established FDA approved treatment to compare it to. But the findings are really encouraging. They suggest that targeting the underlying biology of mTor signaling with cerillymus could potentially serve as an effective topical therapeutic that is well tolerated for improving the overall appearance of aanthosis nercans and improving the quality of life as a result perhaps of the improved appearance in patients who deal with this condition. But but we need larger randomized controlled with placebo controls trials before we really know how effective this actually is before you will likely see it as a go-to recommendation. Although some dermatologists are open to trying things like this out provided they um appear to be safe and with minimal risks and if you're motivated and if they importantly are able to get it covered by insurance, it doesn't become too cost prohibitive to you. Because if you can't afford to pay for the medications, which is not uncommon, okay, medications are expensive. Well, the likelihood of them working goes down, okay, because if you don't have access to them, you can't use them. If you don't use them, they don't work. The biggest takeaway is that it's more than cosmetic, okay? It really affects people's overall quality of life. I get people on my channel here on YouTube as well as in the comments section of my other social media platforms pretty much every day asking me, "What can I do to get rid of the aanthosis nerans?" I've been seeing my doctor for years for my underlying insulin resistance, diabetes, and that's well controlled. And while it looks better, I want it gone. Like, I hate this. How do I get rid of it? And unfortunately, I don't have a good answer for you. You can try the things that I've mentioned here. I do suggest following with your dermatologist. They may have some laser-based devices that effectively target this. Don't despair.

[00:14:18]We do have some emerging and promising research in the pipeline that I think is worth keeping in the back of your mind and remaining hopeful and optimistic.

[00:14:26]I'll be keeping a close eye on this area moving forward uh to see where it goes.

[00:14:31]What direction do we get bigger, better studies, more well-controlled studies?

[00:14:35]Do we get more information on the long-term success? Like, yeah, it improves it, but do you have to keep using it indefinitely in order to maintain that? or does it kind of suppress it to a level where so long as your underlying blood sugars and things are well controlled, the insulin resistance is, you know, well treated, not not an issue? Can you get this to subside and and really calm down and and go back to as normal as humanly possible? I'd also love to hear your comments below like what has your experience been coping with this condition? Have you made much progress in improving the appearance? How have you been tracking your progress? Do you take photographs or is it just by looking? I do always suggest when you have a skin condition, particularly if it bothers you from a quality of life perspective and you're feeling a little like Debbie Downer about the treatment options that you have been pursuing, take photographs because skin improves very slowly, very gradually, and our eyes adapt very quickly to what we are seeing. And so we don't see the change necessarily when we're looking at it over time. But if you can compare snapshots throughout time, then it's like, yeah, definitely looks better. I didn't even realize it. So, I definitely suggest doing that. And likewise, if it's like, I've been doing this for how long now and it looks exactly the same.

[00:15:51]Might be time to make peace with whatever you've been trying and and talk to your dermatologist about, can we put this to rest? I don't think it's doing anything. And here's the documented evidence that it hasn't moved the dial, especially if it's something that you're paying out of pocket for, okay? Cuz money does not grow on trees. All right, y'all. I really hope you found today's video helpful. Now, on this channel, I have an entire playlist of skin signs of underlying uh health problems, insulin resistance. We go into more skin findings there. Obesity, diabetes, thyroid disease, as well as a variety of underlying nutritional deficiencies, you name it. I got a ton of videos, autoimmune diseases, all sorts of stuff.

[00:16:27]Infectious diseases. I mean, even the rare ones like leprosy and haunt virus.

[00:16:33]It's It's chalk full of dermatologic info and tidbits here. For those of you who like to geek out on that kind of stuff, you're in the right place. Check out the playlist. But I hope you enjoyed today's video. If so, give it a thumbs up, share it with your friends, and as always, don't forget sunscreen and subscribe. I'll talk to you guys tomorrow. Bye. [music] [music] Heat.