Management of Acanthosis Nigricans

Diagnostic Approach

The American Academy of Family Physicians suggests examining for presence of acne, hirsutism, or clitoromegaly which may indicate PCOS 3
The American Academy of Family Physicians recommends screening for type 2 diabetes with fasting glucose followed by a two-hour glucose level after a 75-gram glucose load 2
The American Academy of Family Physicians advises considering thyroid function tests and lipid panel to evaluate for other metabolic disorders 2

The American Gastroenterological Association recommends weight reduction as the most effective strategy for obesity-associated acanthosis nigricans, with a target of 7-10% decrease in excess weight for obese patients 1, 4
The American Diabetes Association suggests that a 7-10% decrease in excess weight is a practical management strategy for obese patients 4
The American Academy of Family Physicians recommends treating underlying endocrinopathies such as PCOS 3

The American Diabetes Association notes that acanthosis nigricans in children and adolescents serves as an early marker for insulin resistance and risk for type 2 diabetes 5
The American Diabetes Association advises that distinguishing between type 1 and type 2 diabetes can be challenging in children with AN, and that diabetes-associated autoantibodies and ketosis may be present in pediatric patients with features of type 2 diabetes (including obesity and acanthosis nigricans) 4, 5
The American College of Medical Genetics and Genomics states that in achondroplasia, acanthosis nigricans prevalence is around 10% and may be related to FGFR3 variants rather than impaired glucose tolerance 6