Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.
Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Curr Pediatr Rev. 2022;19(1):68-82. doi: 10.2174/1573396318666220429085231.
Early recognition of acanthosis nigricans is important because acanthosis nigricans can be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy.
The purpose of this article is to familiarize pediatricians with the clinical manifestations, evaluation, diagnosis, and management of acanthosis nigricans.
A search was conducted in November 2021in PubMed Clinical Queries using the key term "acanthosis nigricans". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.
Acanthosis nigricans is characterized by symmetric, hyperpigmented, and velvety plaques with ill-defined borders, typically involving intertriginous areas. Obesity is the most common cause of acanthosis nigricans which is increasingly observed in obese children and adolescents and can serve as a cutaneous marker of insulin resistance. Early recognition of acanthosis nigricans is important because acanthosis nigricans can also be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. This may consist of weight reduction, discontinuation of causative drugs, treatment of underlying endocrinopathy, or treatment of an underlying malignancy. For patients with isolated acanthosis nigricans and for those whose underlying cause is not amenable to treatment, treatment of the lesion may be considered for cosmetic reasons. Topical retinoids, vitamin D analogs, chemical peels, and other keratolytics are often used for the treatment of localized lesions. Seldom, systemic therapy such as oral retinoids may be considered for extensive or generalized acanthosis nigricans and acanthosis nigricans unresponsive to topical therapy. Other uncommon treatment modalities include dermabrasion, laser therapy, and surgical removal.
Although acanthosis nigricans is treatable, a complete cure is difficult to achieve. The underlying cause should be treated, if possible, to resolve and prevent the recurrence of acanthosis nigricans. The diagnosis is mainly clinical, based on the characteristic appearance (symmetrically distributed, hyperpigmented, velvety, papillomatous, hyperkeratotic plaques with ill-defined borders) and the typical sites (intertriginous areas, flexural area, and skin folds) of the lesions. The diagnosis might be difficult for lesions that have atypical morphology or are in an unusual location. Clinicians should be familiar with the clinical signs, evaluation, diagnosis, and therapy of acanthosis nigricans because of the link between it and underlying diseases.
早期识别黑棘皮病很重要，因为黑棘皮病可能是多种系统性疾病的皮肤表现，极少数情况下也可能是内部恶性肿瘤的迹象。
本文旨在使儿科医生熟悉黑棘皮病的临床表现、评估、诊断和治疗。
2021 年 11 月，我们在 PubMed Clinical Queries 中使用关键词“黑棘皮病”进行了检索。该检索策略包括过去 10 年内在所有临床试验、观察性研究和综述中发表的内容。本综述仅纳入了英语文献中的论文。从上述检索中检索到的信息被用于编写本文。
黑棘皮病的特征是对称、色素沉着、天鹅绒样斑块，边界不清，通常累及间擦部位。肥胖是黑棘皮病最常见的原因，在肥胖的儿童和青少年中越来越常见，可作为胰岛素抵抗的皮肤标志物。早期识别黑棘皮病很重要，因为黑棘皮病也可能是多种系统性疾病的皮肤表现，极少数情况下也可能是内部恶性肿瘤的迹象。这可能包括减轻体重、停止引起疾病的药物、治疗潜在的内分泌疾病或治疗潜在的恶性肿瘤。对于单纯性黑棘皮病患者和那些病因无法治疗的患者，出于美容原因，可考虑治疗病变。局部病变常使用局部维 A 酸、维生素 D 类似物、化学换肤和其他角质松解剂治疗。对于广泛或全身性黑棘皮病和对局部治疗无反应的黑棘皮病，有时可考虑全身治疗，如口服维 A 酸。其他罕见的治疗方法包括磨皮术、激光治疗和手术切除。
虽然黑棘皮病是可治疗的，但很难完全治愈。如果可能的话，应治疗潜在病因以解决和预防黑棘皮病的复发。诊断主要基于临床表现，根据病变的特征性外观（对称分布、色素沉着、天鹅绒样、乳头瘤样、边界不清的角化过度斑块）和典型部位（间擦部位、弯曲部位和皮肤褶皱）。对于形态异常或位置异常的病变，诊断可能较为困难。由于黑棘皮病与潜在疾病之间存在关联，因此临床医生应熟悉黑棘皮病的临床表现、评估、诊断和治疗。
