The Obesity Epidemic and the Rise of Acanthosis Nigricans – A Case for Lifestyle Medicine

July 2020 | Volume 19 | Issue 7 | Features | 774 | Copyright © July 2020

Published online June 24, 2020

Rebecca Quinonez MDa, Heather Woolery-Lloyd MDa,b, Kiyanna Williams MDb,c

aDr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL bUniversity of Michigan, Department of Dermatology, Ann Arbor, MI

5-month follow up, the patient reported a 30-pound weight loss and almost complete resolution of the hyperpigmented plaques and an overall improvement in her skin tone and texture.


Acanthosis nigricans, a skin condition more common in skin of color, is an ideal example of how lifestyle interventions can dramatically improve obesity related dermatologic diseases. As dermatologists, we need to acknowledge and embrace lifestyle interventions for the prevention and treatment of certain skin conditions. Although challenging, weight-loss needs to be addressed in obesity-related skin diseases including AN, intertrigo, hidradenitis suppurativa, and psoriasis, in addition to topical therapies. Additionally, this case highlights the importance of considering the diagnosis of AN for facial hyperpigmentation as it is often misdiagnosed and treated as melasma or another pigmentary disorder. Dermatologists need to recognize this common condition in obese patients and emphasize the importance of weight loss and healthy lifestyle changes as treatment options.


The authors report no conflicts of interest.


1. Garrow JS , Webster J. Quetelet's index (W/H2) as a measure of fatness. Int J Obes. 1985;9:147-53.
2. Wassink J, Perreira KM , Harris KM. Beyond race/ethnicity: skin color and cardiometabolic health among Blacks and Hispanics in the United States. J Immigr Minor Health. 2017;19:1018-26.
3. Rafalson L, Pham TH, Willi SM, Marcus M, Jessup A , Baranowski T. The association between acanthosis nigricans and dysglycemia in an ethnically diverse group of eighth grade students. Obesity. 2013;21:E328-33.
4. Lincoln KD, Abdou CM , Lloyd D. Race and socioeconomic differences in obesity and depression among Black and non-Hispanic White Americans. J Health Care Poor Underserved. 2014;25:257-75.
5. Hud JA, Jr., Cohen JB, Wagner JM , Cruz PD, Jr. Prevalence and significance of acanthosis nigricans in an adult obese population. Arch Dermatol. 1992;128:941-4.
6. Ozlu E, Uzuncakmak TK, Takir M, Akdeniz N , Karadag AS. Comparison of cutaneous manifestations in diabetic and nondiabetic obese patients: A prospective, controlled study. North Clin Istanb. 2018;5:114-9.
7. Hales CM, Carroll MD, Fryar CD , Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief. 2017:1-8.
8. Ng HY. Acanthosis nigricans in obese adolescents: prevalence, impact, and management challenges. Adolesc Health Med Ther. 2017;8:1-10.
9. Fu JF, Liang L, Dong GP, Jiang YJ , Zou CC. Obese children with benign acanthosis nigricans and insulin resistance: analysis of 19 cases. Zhonghua Er Ke Za Zhi 2004;42:917-9.
10. Xu S , Xue Y. Pediatric obesity: Causes, symptoms, prevention and treatment. Exp Ther Med. 2016;11:15-20.
11. Brickman WJ, Huang J, Silverman BL , Metzger BE. Acanthosis nigricans identifies youth at high risk for metabolic abnormalities. J Pediatr. 2010;156:87-92.
12. Kong AS, Vanderbloemen L, Skipper B, Leggott J, Sebesta E, Glew R et al. Acanthosis nigricans predicts the clustering of metabolic syndrome components in Hispanic elementary school-aged children. J Pediatr Endocrinol Metab. 2012;25:1095-102.
13. Zhang Y, Zhu C, Wen X, Wang X, Li L, Rampersad S et al. Laparoscopic sleeve gastrectomy improves body composition and alleviates insulin resistance in obesity related acanthosis nigricans. Lipids Health Dis. 2017;16:209.


Kiyanna Williams MD