INTRODUCTION
Acanthosis nigricans (AN) is a common skin condition marked by hyperpigmented, velvety plaques.1 In the United States, AN has a prevalence of 19.4%2 and disproportionately impacts individuals with skin of color.1 This prevalence highlights not only a wide-reaching healthcare concern but also an issue of healthcare inequity. AN is associated with significantly lower levels of self-esteem and higher rates of depression and anxiety.3 Effective management of AN is crucial for alleviating physical symptoms and enhancing overall quality of life.
The recommended management for AN involves treating the underlying disorder.1 However, treating the root cause does not always improve dermatologic symptoms.4 For instance, in hyperinsulinemia-induced AN, oral antihyperglycemic agents may not lessen lesion severity.4 This highlights the necessity of considering skin-directed therapies alongside managing the underlying condition, especially when standard treatments fail to alleviate symptoms.
Despite AN's increasing global prevalence,1 the absence of United States Food and Drug Administration (FDA)-approved treatments for AN poses a significant challenge. Compounding this issue is the absence of a universally accepted visual assessment tool in the scientific community, which is crucial for assessing treatment efficacy in clinical trials.5 Unlike AN, conditions like psoriasis and atopic dermatitis benefit from recognized tools like the Psoriasis Area and Severity Index (PASI) and the Eczema Area and Severity Index (EASI), respectively, aiding in treatment advancements. The absence of a similar tool for AN hinders the development and validation of effective treatments and complicates comparing outcomes across clinical trials.
In this review, we thoroughly evaluate current methods for monitoring AN severity. We focus on key visual aspects like lesion size, pigmentation, and texture. Our objective is to analyze the strengths and weaknesses of existing visual assessment tools. We will discuss these tools chronologically, from the earliest to the most recent.
The recommended management for AN involves treating the underlying disorder.1 However, treating the root cause does not always improve dermatologic symptoms.4 For instance, in hyperinsulinemia-induced AN, oral antihyperglycemic agents may not lessen lesion severity.4 This highlights the necessity of considering skin-directed therapies alongside managing the underlying condition, especially when standard treatments fail to alleviate symptoms.
Despite AN's increasing global prevalence,1 the absence of United States Food and Drug Administration (FDA)-approved treatments for AN poses a significant challenge. Compounding this issue is the absence of a universally accepted visual assessment tool in the scientific community, which is crucial for assessing treatment efficacy in clinical trials.5 Unlike AN, conditions like psoriasis and atopic dermatitis benefit from recognized tools like the Psoriasis Area and Severity Index (PASI) and the Eczema Area and Severity Index (EASI), respectively, aiding in treatment advancements. The absence of a similar tool for AN hinders the development and validation of effective treatments and complicates comparing outcomes across clinical trials.
In this review, we thoroughly evaluate current methods for monitoring AN severity. We focus on key visual aspects like lesion size, pigmentation, and texture. Our objective is to analyze the strengths and weaknesses of existing visual assessment tools. We will discuss these tools chronologically, from the earliest to the most recent.
