Papillary pigment dystrophy of the skin (black acanthosis)

Acanthosis nigricans (papillary-pigmented skin dystrophy) is characterized by hyperkeratosis, hyperpigmentation and papillomatosis of the skin, armpits and other large folds.

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Causes black acanthosis

Hereditary factors, endocrine diseases, obesity, and malignant neoplasms play a role in the development of acanthosis nigricans.

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Pathogenesis

Histologically, the epidermis shows pronounced papillomatosis, hyperkeratosis, slight acaptosis and pigment accumulation in all layers of the skin; in the dermis - pronounced papillomatosis, vascular dilation; in the papillary layer - moderate perivascular lymphoid infiltrate.

Symptoms black acanthosis

There are the following clinical forms of the disease: benign (juvenile); not associated with endocrine, hereditary diseases and tumor process; associated with endocrine and hereditary diseases; malignant (paraneoplastic), occurring in individuals with tumors of internal organs, and pseudoacanthosis.

Dermatosis manifests itself in childhood, the initial clinical signs are common to all types of the disease. Dermatosis is characterized by the appearance of hyperpigmentation areas, hyperkeratosis of the skin mainly in the armpits, inguinal-femoral and intergluteal folds, knee and elbow folds, as well as on the lateral surfaces of the neck, around the navel, etc. The skin is dry, brownish in color, then becomes black, its pattern intensifies, the relief becomes rougher, increased folding and papillomatous growths appear. Keratosis on the palms and soles, multiple fibromas, pigment spots like freckles may be noted. Hair and nails are often dystrophic. Subjective sensations are itching, tightness of the skin.

The benign (juvenile) form occurs in early childhood or adolescence and persists throughout life. The clinical picture of skin lesions is similar to that described above.

Acanthosis nigricans may be associated with endocrine disorders (hypothyroidism, insulin-resistant diabetes mellitus, Addison's disease, Cushing's disease).

The paraneoplastic form develops in adults and is characterized by pronounced skin changes with particularly intense gray-black hyperpigmentation, roughening of the skin texture and pronounced papillomatous growths. The treatment process involves the mucous membrane of the gastrointestinal tract and vagina. Damage to the dorsal surfaces of the hands and feet is noted, but according to the type of Hopf acrokeratosis.

In 15-20% of cases, skin manifestations precede the clinical manifestations of cancer by several years; in 60-65%, they appear simultaneously with cancer symptoms, and in 20-25%, after the detection of a malignant neoplasm.

Pseudoacanthosis develops in obese women against the background of dysfunction of the endocrine system, in particular the ovaries, and also under the influence of a hot climate. Papillomatous growths are weakly expressed or absent.

Diagnostics black acanthosis

Differential diagnosis is made between individual forms of acanthosis nigricans. The diagnosis is not difficult and is based on the clinical and histological picture.

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Treatment black acanthosis

Treatment of papillary-pigmented skin dystrophy (acanthosis nigricans) is symptomatic. In the benign form, vitamin therapy and general tonics are prescribed. In severe cases, aromatic retinoids, cytostatics, etc. help.

In the paraneoplastic form, tumor removal is indicated, after which the skin process regresses. 1-2% salicylic ointment and softening creams are applied externally.