The underlying pathogenesis of obesity-associated acanthosis nigricans: a literature review

Abstract

Acanthosis nigricans (AN) presents as hyperpigmented plaques with ill-defined borders, commonly in intertriginous areas and flexures, and is associated with various factors, including obesity, insulin resistance, and malignancies. Recognizing the clinical significance of ANs relationship with metabolic syndrome and cardiovascular risk is important for early intervention and prevention. This study describes the metabolic pathways underlying AN, highlighting its association with hyperinsulinemia, insulin-like growth factor 1 (IGF1), leptin, and their receptors. The pathophysiology involves disruptions in insulin, IGF1, leptin, fibroblast growth factor receptors (FGFR) and epidermal growth factor receptors (EGFR), leading to keratinocyte and fibroblast proliferation. A comprehensive literature search through PubMed was performed. Terms such as “Acanthosis nigricans”, “hyperinsulinemia”, “cardiovascular disease”, “diabetes”, “coronary artery disease”, “hyperleptinemia”, “obesity”, “leptin”, “epidermal growth factor”, “insulin resistance”, were brought into consideration. Further articles were found using source materials from included references. Articles published from 1980 to 2023 were used to encompass the broad range of research covered on the subjects. AN is connected to insulin, IGF1, leptin, and growth factor receptors and is an independent marker for metabolic disorders. Dermatologists may intervene by referring to primary care or by addressing underlying causes such as obesity and hyperinsulinemia, emphasizing the importance of weight loss. Various treatments—including medication, topical therapies, and laser modalities—may provide limited improvement. Recognizing AN's significance in cardiovascular and metabolic disease could ote detection and prevention of cardiovascular diseases, improving patient outcomes. AN is an independent marker for metabolic disorders and its potential for further prompting into a metabolic and cardiovascular risk assessments or referral. Recognizing the metabolic connections in AN is important for dermatologists in intervening early and preventing cardiovascular and metabolic comorbidities.