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SHORT COMMUNICATION
Year : 1990  |  Volume : 56  |  Issue : 6  |  Page : 460-461

Oestrogen induced acanthosis nigricans



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K Pavithran


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How to cite this article:
Pavithran K. Oestrogen induced acanthosis nigricans. Indian J Dermatol Venereol Leprol 1990;56:460-1

How to cite this URL:
Pavithran K. Oestrogen induced acanthosis nigricans. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 May 29];56:460-1. Available from: http://www.ijdvl.com/text.asp?1990/56/6/460/3605


A 54 year old females developed an irregular, hard nodule of 4 X 5 cm on the left breast in June 1988. The histopathological study of the biopsy specimen taken from the nodule revealed features of adenocarcinoma of the breast. Since the tumour was limited to the breast and there was no involvement of the regional lymph nodes, she was treated by segmental resection of the tumour and postoperative irradiation of the areas of axillary, internal mammary and supraclavicular lymph nodes on the left side with a total dose of 4000 rads. She was also given tab.ethinyloestradiol 0.5 mg daily for 8 months. Since last 6 months, while on ethinylestradiol she noticed diffuse hyperpigmentation and thickening of the skin of the body folds, nipple, areola and umbilicus. Examination revealed symmetric, brownish black hyperpigmentation and papillomatous thickening of the skin of the axillae, groin, nape of the neck and umbilicus. Nipple and areola of the left breast showed marked hyperpigmentation and pap-illomatous thickening [Figure - 1] There was a linear scar on the left breast. There was no lump in the breast and the regional lymph nodes were not enlarged. The patient was not obese. Rectal and vaginal examinations were normal. All other systems were normal.

Routine laboratory tests on blood, urine and stools were normal. The levels of sugar, urea and cholesterol were all normal in the blood. The histopathologic study of the biopsy specimens taken from the skin of areola and the axilla revealed hyperkeratosis, moderate acanthosis and marked papillomatosis and the features were suggestive of acanthosis nigricans. Ethinyloestradiol was stopped and she was followed up. When seen after 4 months, there was about 80% diminution in the thickening of the skin and the pigmentation had become somewhat lighter. The patient is still on follow up. The clinical features of acanthosis nigricans are so characteristic that elaborate laboratory tests are seldom required for its diagnosis. But its occasional association with internal malignancy, especially in the elderly individuals warrants detailed clinical examination and laboratory tests. The skin lesions in cur patient were quite suggestive of acanthosis nigricans and it was further confirmed by histopathologic studies. Frequently the cancer and acanthosis nigricans occur simultaneously. But occasionally the skin lesion may precede the development of cancer or it may develop after the occurrence of cancer. The exact mechanism of development of acanthosis nigricans in our case is not known. It is well-known that acanthosis nigricans may occur in association with carcinoma of the breast. But in our patient at the time of developing the skin lesions, there was no evidence of local recurrence of cancer or its distant metastasis. Further the skin lesions started regressing after stopping ethinylestradiol. All these suggested that acanthosis nigricans was induced by ethinylestradiol in this patient. Only a few cases of oestrogen-induced acanthosis nigricans have been reported in the literature. Banuchi et al[1] reported two boys with childhood muscular dystrophy who developed acanthosis nigricans following diethylstilbestrol therapy. Among the cases studied by Brown and Winkelmann[2], 22% were associated with endocrinologic abnormalities or the ingestion of diethylstilbestrol, cortisone, or niacin. It may rarely occur in persons handling diethylstilbestrol treated chickens.[3] The exact mechanism how oestrogen produces skin changes characteristic of acanthosis nigricans is not well understood. Hypermelanosis of one nipple has been produced by the topical application of oestrogen to a guinea pig nipple.[4] The papillomatosis may be stimulated in part by oestrogen - induced local increase in blood flow,[5] and increased deposition of perivascular acid mucopolysaccharides.[6]

 
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1.Banuchi SR, Cohen L, Lorincz AL et al: Acanthosis nigricans following diethylstilbestrol therapy, Arch Dermatol, 1974; 109: 545-546.  Back to cited text no. 1    
2.Brown J and Winklemann RK: Acanthosis nigricans: A study of 90 cases, Medicine, 1968; 47: 33-51.  Back to cited text no. 2    
3.Katzenellenbogan T: Dermatoendocrinological syndrome due to diethylstilbestrol (Harefuah 1956; 50:241) Abstracted in J A M A, 1956; 161: 1695- 1696.  Back to cited text no. 3    
4.David ME: Studies on pigmentation of endocrine origin, J Clin Endocrinol Metabol, 1945; 5: 138145.  Back to cited text no. 4    
5.Reynolds SPM and Foster FI: Peripheral vascularisation of oestrogens in human male, J Clin Invest, 1939; 18: 649-655.  Back to cited text no. 5    
6.Schiff M and Burn HF: The effect of intravenous oestrogens in ground substance, Arch Otolaryngol, 1961; 73: 63-71.  Back to cited text no. 6    


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This article has been cited by
1 Acanthosis nigricans without diabetes during pregnancy
Kroumpouzos, G., Avgerinou, G., Granter, S.R.
British Journal of Dermatology. 2002; 146(5): 925-928
[Pubmed]



 

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