Continuous-wave carbon dioxide laser therapy in pseudoacanthosis nigricans

Comparative study between fractional carbon dioxide laser versus retinoic acid chemical peel in the treatment of acanthosis nigricans

BACKGROUND

Acanthosis nigricans (AN) is a common dermatological issue with several therapeutic modalities to treat. Despite retinoid is the first drug of choice in the treatment, the fractional-ablative carbon dioxide (CO₂ ) laser has revealed as a promising procedure for the management of neck-AN, outstanding to its ability for superficial ablation of the skin surface, with trans-epidermal melanin elimination.

OBJECTIVES

To decide whether fractional-ablative CO₂ laser or retinoic acid (5%) peel is the more effective and safe choice for AN treatment.

METHODS

In this study, twenty Egyptian cases with neck-AN were enrolled, where each case was exposed to four sessions with 2 weeks apart of both fractional CO₂  laser on the right half of the neck and retinoic acid peel on the left half of the neck. Cases were assessed by a scoring system: Acanthosis Nigricans Area and Severity Index (ANASI) score, two blinded dermatologists, and dermoscopically before and one month after treatment.

RESULTS

We found a highly statistically significant improvement among both treated groups regarding (ANASI) score and dermatologist's assessments. Bedside, the degree of sulci cutis, cristae cutis, brown-to-dark brown dots, and milia-like cysts, dermoscopic sign improvement was evident in both treated groups. However, fractional CO₂ laser shows the superior result to retinoic acid peel in the treatment.

CONCLUSION

Fractional CO₂ laser and retinoic acid peel are considered effective modalities for neck-AN treatment. However, fractional CO₂ laser was more effective.

Juvenile acanthosis nigricans

Acanthosis nigricans is a velvety thickening of the epidermis that primarily affects the axillae, posterior neck fold, flexor skin surfaces, and umbilicus, and infrequently is diffuse with involvement of the mucosal surfaces. It is increasingly seen in children and adolescents who are obese, and can serve as a cutaneous marker of insulin resistance and malignancy. Although malignancy-associated acanthosis nigricans is rare in the pediatric population, one need be concerned about its association with certain pediatric syndromes. More importantly, insulin resistance itself can also represent a threat to life. We review this important disorder.