Options for Treating Acanthosis Nigricans

Acanthosis nigricans on the neck
Vandana Mehta Rai MD DNB, C Balachandran MD [ CC BY-SA 3.0], via Wikimedia Commons

Acanthosis nigricans is patches of dark, thickened, velvety skin that can appear on the neck, on the thighs, or on the vulva. The condition itself isn't harmful or contagious, although you may not like its appearance. But it can be the sign of other medical conditions and so it is a concern to bring up with your doctor.


Acanthosis nigricans can be seen in otherwise healthy people, so it is not always related to a medical condition. However, it is associated with these conditions:

  • Obesity is the most common association, and losing weight can reverse it.
  • Genetic disorders including Down syndrome
  • Rarely, in cancers of the digestive tract, liver, kidney, bladder, or lymphoma
  • Polycystic ovary syndrome (PCOS) and ovarian cysts
  • Birth control pills, human growth hormone, high-dose niacin, prednisone, and some other medications
  • Type 2 diabetes: 75 percent of children with type 2 diabetes develop acanthosis nigricans. Adults with diabetes may develop it as well.

Insulin resistance means that your body is not responding as well to insulin as it could be (this happens in people with PCOS and people who are pre-diabetic, for example). Insulin causes glucose to be taken into the body cells to be used for energy. Someone with insulin resistance will require larger and larger amounts of insulin to be secreted before glucose is taken into the body tissues, and eventually change the way the body deals with sugar. One of these ways is making extra pigment.

Signs and Symptoms

Dark, thickened, velvety skin slowly develops in areas of your body where there are skin folds. These areas typically are in the armpits, groin, and the fold of the neck. Some people call the line on the neck the sugar line or sugar necklace (due to the association with diabetes). The pigmentation may also appear over the joints in your fingers and toes.

The skin stays soft, unlike some other syndromes where the skin toughens. Less often, the pigmentation will appear on the lips, palms or soles, and more frequently that is associated with those who have cancer.


Report the symptoms of acanthosis nigricans to your doctor. She will examine your skin and can usually diagnose it based on its appearance. But she will also likely order blood tests for blood sugar level or insulin level. You may also undergo endoscopy or X-rays to check for cancer and other causes.


Primary treatment of acanthosis nigricans aims to correct the underlying cause. Weight loss and reversing insulin resistance are the most effective ways to eliminate any skin changes. It is reversible and will disappear as the cause is treated.

There are cosmetic options if the acanthosis nigricans is severe or not being managed by weight loss. Treatments include laser therapy, topical retinoids, and dermabrasion. Topical retinoids increase shedding of normal skin cells, which can reduce the appearance of the lesions. Both dermabrasion and laser therapy are procedures that should be performed only by a certified dermatologist.

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