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Acanthosis Nigricans

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Acanthosis Nigricans is a non-specific skin finding. The most common presentation is thickening of the skin. This is usually present at the skin folds such as around the neck, in the armpit, in the groin, under breasts and under skin folds of the abdomen. There are a number of metabolic conditions where the skin findings may be the first presentation. The table below outlines some of those conditions.

One of the most common metabolic conditions associated with morbid obesity and weight loss surgery is insulin resistance. The skin finding of Acanthosis Nigricans, is a representation of severe insulin resistance within the tissue. The research has identified antibodies to the insulin receptor that results in thickening of the skin. This clinical condition does not mean that the patient has diabetes, only that there is a discrepancy between the level of the insulin that is required to normalize the blood sugar. However, is the underlying cause, obesity, is not corrected, it is almost for certain that the patient will develop diabetes.

The hyperpigmentation is the result of papillary hypertrophy, hyperkeratosis, and an increase in the number of melanocytes in the epidermis. Epidermis is the outermost layer of the skin. For the most part these skin changes are not reversible. The hyperpigmentation and the thickening of the epidermal layer stops once the underlying metabolic condition(s) are corrected.

Duodenal switch operation corrects the underlying metabolic abnormalities that result in insulin resistance.

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