|Year : 1996 | Volume
| Issue : 3 | Page : 159-161
Topical tretinoin in acanthosis nigricans
Koushik Lahiri, Subrata Malakar
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
Acanthosis nigricans is characterised by hyperkeratosis and pigmentation with papillomatous elevation which gives it a velvety texture. The present study includes only the idiopathic cases of the original classification., 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|| |
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|| |
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 [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|| |
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.
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.
Treatment of pseudoacanthosis nigricans with 0.1% tretinoin twice daily for 2 weeks reportedly showed a decrease in both hyperpigmentation and hyperkeratosis. 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. Treatment of acanthosis nigricans with tretinoin is reported in recent papers also.
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|| |
|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. |
|2.||Brown I, Winkelmann RK. Acanthosis nigricans : a study of 90 cases. Medicine 1968;47:33-51. |
|3.||Lever WF, Lever GS. Metabolic diseases. In : Histopathology of skin. Philadelphia : JB Lippincott, 1990:452-82. |
|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. [PUBMED] |
|5.||Elias P, Fritsch PO, Lampe M, et al. Retinoid effects on epidermal structure, differentiation, and permeability. Lab Invest 1981;44:531-9. |
|6.||Kligman AM, Grove GL, Hirose R, et al. Topical tretinoin for photoaged skin. J Am Acad Dermatol 1986;15:836-59. [PUBMED] |
|7.||Bergen BJ, Gross PR. Another use for tretinoin-pseudoacanthosis nigricans. Arch Dermatol 1973;108:133-4. |
|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. |
|9.||Darmstadt GL, Yokel BK, Horn TD. Treatment of acanthosis nigricans with tretinoin. Arch Dermatol 1991;127:1139-40. [PUBMED] |
[Figure - 1], [Figure - 2]
[Table - 1], [Table - 2]