IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 1093 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
   [PDF Not available] *
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
   Introduction
   Materials and Me...
   Results
   Discussion
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed9398    
    Printed109    
    Emailed2    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal

 


 
SHORT COMMUNICATION
Year : 1996  |  Volume : 62  |  Issue : 3  |  Page : 159-161

Topical tretinoin in acanthosis nigricans




Correspondence Address:
Koushik Lahiri


Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 20948022

Rights and PermissionsRights and Permissions

  Abstract 

Efficacy of topical tretinoin was assessed in 30 cases of idiopathic acanthosis nigricans which were recalcitrant to conventional modalities of treatment. Topical tretinoin once at night application was found to be very effective both clinically and histologically.


Keywords: Acanthosis nigricans, Tretinoin


How to cite this article:
Lahiri K, Malakar S. Topical tretinoin in acanthosis nigricans. Indian J Dermatol Venereol Leprol 1996;62:159-61

How to cite this URL:
Lahiri K, Malakar S. Topical tretinoin in acanthosis nigricans. Indian J Dermatol Venereol Leprol [serial online] 1996 [cited 2018 Dec 16];62:159-61. Available from: http://www.ijdvl.com/text.asp?1996/62/3/159/4360



  Introduction Top


Acanthosis nigricans is characterised by hyperkeratosis and pigmentation with papillomatous elevation which gives it a velvety texture.[1] The present study includes only the idiopathic cases of the original classification.[2],[3] The effect of topical tretinoin (0.05%) was observed in those cases which were not esponding satisfactorily or resistant to conventional modalities of management.


  Materials and Methods Top


The study group comprised 30 cases of acanthosis nigricans. Age ranged between 14-42 years, 23 of them were female and 7 male. They were suffering for varying duration. Cases due to secondary causes (malignancy, drugs etc) were excluded and in the present study only the idiopathic cases were dealt with.

Topical tretinoin (0.05%) was applied over the affected areas once at night, patients were followed up fortnightly for 2 months and then monthly for another 2 months. Biopsies were done both before and after in selected cases.

Relapse was noted within a period of 4 weeks after discontinuation of topical tretinoin. These patients were put on a twice weekly intermittent regimen. Stray cases of local irritation after tretinoin application were managed with emollient cream.


  Results Top


Clinical improvement was evident in all cases after 2 weeks of application of tretinoin (0.05%). Atleast 50% improvement of the velvety appearance was seen within 6 weeks. 24/30 patients (80%) showed total clearance of lesions after 16 weeks [Table - 1].

Hyperpigmentation was comparatively resistant. Only 7/30 cases (23%) showed total clearance at the end of our study [Table - 2]. One patient went on applying tretinoin daily rather over enthusiastically, even after complete clearing of lesion and after 8 weeks reported with hypopigmentation over the area.

Histopathologically hyperkeratosis and typical keratotic material in the valleys between the papillae were seen[3] [Figure - 1]. After 8 weeks of tretinoin application the epidermis looked quite normal [Figure - 2]).

Relapsed cases were managed effectively with a twice weekly intermittent application regimen.


  Discussion Top


Acanthosis nigricans is usually resistant to treatment. If an underlying cause is there (eg malignant tumour) removal of it may improve the condition, which is however, rarely complete.[1]

The action of tretinoin on the epidermis is well substantiated in various papers. It is definitely epidermopoietic and causes reduction of stratum corneum replacement time.[4-5] It corrects hyperkeratosis and nearly complete reversion to the normal state is also reported.[6]

Treatment of pseudoacanthosis nigricans with 0.1% tretinoin twice daily for 2 weeks reportedly showed a decrease in both hyperpigmentation and hyperkeratosis.[7] Complete nerve deafness, progressive peripheral sensory nerve demyelination, loss of gastric antral motility, multiple diverticula in the ileum and steatorrhoea associated with extensive acanthosis nigricans responded to twice weekly application of 0.1% retinoic acid ointment.[8] Treatment of acanthosis nigricans with tretinoin is reported in recent papers also.[9]

In our study we used 0.05% tretinoin in cream base once at night and the results are quite encouraging and comparable with the results of other studies using more frequent applicatoin schedule of higher concentration of tretinoin. But it was also found that intermittent tretinoin application was needed to maintain the improved status.

 
  References Top

1.Griffiths WAD, Leigh IM, Marks R. Disorders of keratinization. In : Champion RH, Burton JL, Ebling FJG, editors. Textbook of dermatology. London : Blackwell, 1992;1325-90.  Back to cited text no. 1    
2.Brown I, Winkelmann RK. Acanthosis nigricans : a study of 90 cases. Medicine 1968;47:33-51.  Back to cited text no. 2    
3.Lever WF, Lever GS. Metabolic diseases. In : Histopathology of skin. Philadelphia : JB Lippincott, 1990:452-82.  Back to cited text no. 3    
4.Milstone LM, McGuire J, Lavigne JF. Retinoic acid causes premature desquamation of cells from confluent cultures of stratified squamous epithelia. J Invest Dermatol 1982;79:253-8.  Back to cited text no. 4  [PUBMED]  
5.Elias P, Fritsch PO, Lampe M, et al. Retinoid effects on epidermal structure, differentiation, and permeability. Lab Invest 1981;44:531-9.  Back to cited text no. 5    
6.Kligman AM, Grove GL, Hirose R, et al. Topical tretinoin for photoaged skin. J Am Acad Dermatol 1986;15:836-59.  Back to cited text no. 6  [PUBMED]  
7.Bergen BJ, Gross PR. Another use for tretinoin-pseudoacanthosis nigricans. Arch Dermatol 1973;108:133-4.  Back to cited text no. 7    
8.Montes LF, Hirschowitz BI, Krumdiek C. Acanthosis nigricans and hypovitaminosis A : response to topical vitamin A acid. J Cutan Pathol 1974;1:88-94.  Back to cited text no. 8    
9.Darmstadt GL, Yokel BK, Horn TD. Treatment of acanthosis nigricans with tretinoin. Arch Dermatol 1991;127:1139-40.  Back to cited text no. 9  [PUBMED]  


    Figures

[Figure - 1], [Figure - 2]

    Tables

[Table - 1], [Table - 2]



 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow