Clinical Implications and Management of Acanthosis Nigricans of the Neck

Epidemiology & Key Associations

In individuals with obesity, neck‑located acanthosis nigricans (AN) signals dyslipidemia characterized by elevated triglycerides, increased LDL‑cholesterol, and reduced HDL‑cholesterol. 1
Among women, AN is strongly linked to polycystic ovary syndrome (PCOS), frequently co‑occurring with chronic anovulation, hyperinsulinemia, and lowered sex‑hormone‑binding‑globulin levels. 1
When AN appears in non‑obese patients without evident metabolic risk factors, clinicians should suspect a paraneoplastic etiology such as insulinoma or gastric adenocarcinoma. 1

Metabolic screening – Perform a fasting plasma glucose measurement followed by a 2‑hour oral glucose tolerance test (75 g glucose load) as the ACOG‑endorsed standard for any patient displaying cutaneous signs of insulin resistance. 1
Lipid assessment – Obtain a fasting lipid panel to detect the dyslipidemic pattern (high triglycerides, high LDL, low HDL) associated with AN. 1
Thyroid evaluation – Measure thyroid‑stimulating hormone (TSH) to rule out thyroid disease as a contributing factor. 1
Female endocrine work‑up – In women, assess serum prolactin and total/free testosterone to identify PCOS‑related hyperandrogenism. 1
Cushing’s syndrome screening – If clinical stigmata of Cushing’s (e.g., centripetal obesity, facial rounding, hypertension, striae) are present, initiate formal biochemical testing. 1
Malignancy investigation – For non‑obese patients, rapid AN onset, or constitutional symptoms, consider imaging (plain radiography, ultrasound, CT/MRI) and upper gastrointestinal endoscopy to detect gastric adenocarcinoma. 1

PCOS – Implement hormonal therapy to correct hyperandrogenism and restore ovulation while concurrently addressing insulin resistance (e.g., lifestyle modification, insulin‑sensitizing agents). 1
Malignancy‑associated AN – Treat the primary cancer; resolution of the skin changes typically follows successful oncologic therapy. 1

Oral glucose tolerance testing – Relying solely on fasting glucose can miss early glucose intolerance; OGTT is essential for timely detection of pre‑diabetes or diabetes in patients with AN. 1
Recognition of non‑obese presentations – Although obesity accounts for roughly 80 % of AN cases, clinicians must actively evaluate non‑obese individuals to exclude paraneoplastic causes. 1
Cardiovascular risk assessment – Patients with AN and insulin resistance carry a markedly increased risk of cardiovascular disease due to the accompanying dyslipidemia and metabolic syndrome; comprehensive risk stratification and management are warranted. 1

Acanthosis nigricans serves as an important clinical marker for metabolic disorders, particularly in children and adolescents, where it can be an early indicator of insulin resistance and risk for type 2 diabetes 2

Weight reduction is considered the most effective strategy for obesity-associated acanthosis nigricans 2
A target of 7-10% decrease in excess weight is recommended for obese patients with AN 2
Management should focus on identifying and treating underlying endocrinopathies such as PCOS 2
Screening for type 2 diabetes with fasting glucose and a two-hour glucose tolerance test is recommended 2
Additional testing should include thyroid function tests and lipid panels to evaluate for other metabolic disorders 2

Saroglitazar is a dual PPAR-α/γ agonist with effects on lipid metabolism and insulin sensitivity 3
It modulates adhesion molecule expression and provides anti-inflammatory effects through PPAR-α/γ-mediated mechanisms 3

The American Association for the Study of Liver Diseases notes that thiazolidinediones (PPAR-γ agonists) can improve liver histology in NAFLD 4
Saroglitazar has been studied for non-alcoholic fatty liver disease (NAFLD) 4, 5