Discussions By Condition: Skin conditions

long term acanthosis nigricans, non diabetic

Posted In: Skin conditions 2 Replies
  • Posted By: Anonymous
  • May 11, 2009
  • 07:37 PM

I have a friend, female, celtic, 38, 164cm, 60kg, wheat and gluten intolerant.

She has the appearance of acanthosis nigricans on the front of her neck in a band from ear to ear extending about 4cm down her throat. It's fine-pebbly, gray, uniform and matches what photos I've seen on Google. She's not, as far as she knows, diabetic. It's been there at about nine years without much variation. The last doctor she showed it to treated it as eczema and she's never been back. She's occasionally dizzy but she doesn't faint.

I'm puzzled firstly that it's on the front of her neck and not the back. Does that indicate acanthosis nigricans is a wrong description despite the similarity of the look?

If it's right then I presume it's caused by a raised insulin level and ought to be investigated. Finding a doctor who would take it seriously enough to check has been the reason it's not been done.

Is the food intolerance possibly associated?

Her comment on reading this is: "I have had no specific treatment for that area alone ever, just the dermatologist calling it staining when the nurse asked him what it could be, that was at a general run of the mill check up after my discharge from hospital". The only "treatment" she's tried is rubbing it raw with frustration trying to get rid of it.

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2 Replies:

  • Not a lot of feedback there then. Never mind, I was only taking a shot in the dark.Here's the note I've written for her to take to her doctor:Could you please arrange the following tests.1. Plasma insulin level. http://www.isletsofhope.com/diabetes/problems/acanthosis_nigricans_an_1.html#treatmentScreen for insulin resistance; a good screening test for insulin resistance is a plasma insulin level, which will be high in those with insulin resistance. This is the most sensitive test to detect a metabolic abnormality of this kind because many younger patients do not yet have overt diabetes mellitus and an abnormal glycosylated hemoglobin level, but they do have a high plasma insulin level. 2. ACTH Stimulation TestACTH (adrenocorticotropin) Stimulation. http://endocrine.niddk.nih.gov/pubs/addison/addison.htm#diagnosisThis is the most specific test for diagnosing Addison's disease. In this test, blood cortisol, urine cortisol, or both are measured before and after a synthetic form of ACTH is given by injection. In the so-called short, or rapid, ACTH test, measurement of cortisol in blood is repeated 30 to 60 minutes after an intravenous ACTH injection. The normal response after an injection of ACTH is a rise in blood and urine cortisol levels. Patients with either form of adrenal insufficiency respond poorly or do not respond at all.(subsequently perhaps) CRH Stimulation TestWhen the response to the short ACTH test is abnormal, a "long" CRH stimulation test is required to determine the cause of adrenal insufficiency. In this test, synthetic CRH is injected intravenously and blood cortisol is measured before and 30, 60, 90, and 120 minutes after the injection. Patients with primary adrenal insufficiency have high ACTHs but do not produce cortisol. Patients with secondary adrenal insufficiency have deficient cortisol responses but absent or delayed ACTH responses. Absent ACTH response points to the pituitary as the cause; a delayed ACTH response points to the hypothalamus as the cause.In patients suspected of having an addisonian crisis, the doctor must begin treatment with injections of salt, fluids, and glucocorticoid hormones immediately. Although a reliable diagnosis is not possible while the patient is being treated for the crisis, measurement of blood ACTH and cortisol during the crisis and before glucocorticoids are given is enough to make the diagnosis. Once the crisis is controlled and medication has been stopped, the doctor will delay further testing for up to 1 month to obtain an accurate diagnosis.3. Subsequent evaluation of Acanthosis Nigricans on anterior neck on the basis of the results.
    Anonymous 42789 Replies Flag this Response
  • I have a friend, female, celtic, 38, 164cm, 60kg, wheat and gluten intolerant. I'm puzzled firstly that it's on the front of her neck and not the back. Does that indicate acanthosis nigricans is a wrong description despite the similarity of the look? Possibly so, as you are correct in that the front of the neck is not a common place for AN. If it's right then I presume it's caused by a raised insulin level and ought to be investigated. Not always. In fact, there are lots of people who have AN and are not diabetic....yet..... Is the food intolerance possibly associated? If it's truely AN, then no. If however it is a remnant of a previous rash like dermatitis herpetiformis, then possibly so. Her comment on reading this is: "I have had no specific treatment for that area alone ever, just the dermatologist calling it staining when the nurse asked him what it could be, that was at a general run of the mill check up after my discharge from hospital". The only "treatment" she's tried is rubbing it raw with frustration trying to get rid of it. She should find a dermatologist that will take her seriously and give her a straight answer, or at least do the investigative procedures that will enable them to give her a straight answer.
    Caladan 87 Replies Flag this Response
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