Acanthosis nigricans in the pediatric population: a narrative review of the current approach to management in primary care

Background and Objective: Acanthosis nigricans (AN) is frequently seen in obese and overweight children and adolescents. Current research suggests an association with insulin resistance, type 2 diabetes mellitus, and obesity, and often primary care physicians are the first point of contact for individuals with this dermatologic condition. However, identifying the condition at an early stage may be difficult. This narrative review aims to provide readers with a comprehensive overview of the current literature of AN in the pediatric and adolescent population, including best practices for identifying the condition, with a focus on the recommended management in the primary care setting to enable early and enhanced intervention. Methods: We identified case and cross-sectional studies, clinical trials, and literature reviews of pediatric AN for ages 0 to 18 years in the United States and internationally. We considered publications for background from 1994 to 2007 and publications for approach to management from 2007 to 2020. Key Content and Findings: The literature review contains information on the recommended work up of a patient with AN, with a special focus on insulin resistance. AN may be present prior to diabetes, and the severity of AN can be used as a clinical predictor of metabolic disorders and the underlying nutritional status of normal, overweight, and obese children and adolescents. Early metabolic screening with focus on insulin sensitivity, liver function, lipid panel, and glucose tolerance is recommended. Conclusions: AN in the pediatric population can be a harbinger for underlying metabolic syndrome and insulin resistance. A thorough investigation and appropriate screening of children at risk, with a focus on early identification of the dermatologic condition and its associated comorbidities in the primary care setting, and early treatment is recommended to prevent long term consequences and decrease the risk of cardiovascular complications.