For acanthosis nigricans requiring systemic intervention, evidence-based oral therapy is available. The treatment goal is complete resolution of skin lesions, guided by a structured first-line protocol.
The protocol covers oral systemic therapy, encompassing retinoid-class agents and, where insulin sensitization is clinically relevant, insulin-sensitizing therapy. Additional oral systemic options are also included. The full protocol specifies selection criteria, sequencing, and monitoring.
Complete resolution of acanthosis nigricans skin lesions.
Extensive AN associated with obesity has been successfully treated with isotretinoin (3 mg/kg/day), but relapsed when treatment was discontinued.
One case showed that an 18-year-old male with generalized idiopathic AN experienced complete recovery after 45 days of acitretin 0.8 mg/kg (50 mg) divided into two daily doses.
After starting maintenance therapy of 25 mg acitretin daily for 2 months, lesions recurred that subsequently resolved with topical application of 0.1% retinoic acid.
One recent clinical trial conducted in India treated 40 patients with AN and insulin resistance (detected by the Homeostatic Model Assessment for Insulin Resistance) with 500 mg metformin thrice daily for 3 months.
All the patients had previously failed topical therapy for AN, either with calcipotriol or with corticosteroids.
The long-term use of ocreotide, a synthetic analog of somatostatin, sustained improvement of AN and reduction of body weight in a severely obese boy with insulin resistance 6 months after treatment cessation.
Complete resolution at day 45 with mild recurrence that resolved with topical 0.1% retinoic acid applied daily.
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