Hey guys, Sandra Lee, M.D. (aka Dr. Pimple Popper), here!

I see you’ve found The Pretty Pimple — I hope you’re enjoying the articles and learning something new! I’ve heard your requests for effective, acne-fighting products, and that’s why I’m so excited to introduce SLMD Skincare to you guys. This line exists to provide solutions for the skincare concerns you popaholics have always asked me about. These products bring together the most effective, blemish-banishing ingredients, so you can treat your skin with clinical confidence.

xo, Sandra

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Strange Dark Skin Patches? It Could Be Acanthosis Nigricans

What do birth control pills, diabetes, and polycystic ovarian syndrome all have in common? They can all cause discoloration of the skin!

That’s right — all three of these seemingly unrelated health care topics can cause acanthosis nigricans, a skin condition characterized by dark, thickened, velvety patches of skin mostly found in creases and skin folds on the body, namely in the armpits, groin, neck, elbows, knees, knuckles, lips, palms, and feet.


What causes acanthosis nigricans?

Increased insulin levels can lead to the discoloration or changes in texture in a person’s skin, but the causes of these increased insulin levels vary. Insulin is a hormone that our pancrease produces to help our body process sugar. You’ve probably heard about those with diabetes, who need more insulin because their body can’t properly digest sugary foods. Well, he most common cause of acanthosis nigricans is insulin resistance, especially in individuals who are at risk of contracting type 2 diabetes.

Certain hormonal disorders such as cysts, thyroid abnormalities, and gland problems can also be to blame. Hormonal medications like birth control pills and some supplements can also increase insulin production — or heighten risk of resistance in some patients — which can then lead to acanthosis nigricans. In some rare cases, acanthosis nigricans could occur because a patient has lymphoma or cancer in the stomach, liver, or other internal organ.

Courtesy of mylifemag.blogspot.com.

I think I might have acanthosis nigricans. Should I be worried?

Not necessarily. Most commonly, hormonal imbalances that trigger the discoloration and change in the skin’s texture that’s characteristic of acanthosis nigricans can be caused by medication or supplements, insulin resistance, or diabetes. A recent study found that about 30% of Polycystic Ovarian Syndrome (PCOS) patients also have acanthosis nigricans. So before you start freaking out, talk to your doctor about all the possible causes of your condition. Diagnosis could range from a simple evaluation of diet and exercise habits to blood tests and x-rays.

Courtesy of webmd.boots.com.

Really, PCOS causes this? How does a reproductive disorder cause a skin condition?

Let’s back up for this one. If you’re unfamiliar, PCOS is a reproductive health condition in which hormonal imbalances affect a patient’s ovaries. This can cause irregular menstruation, irregular hair growth, weight gain, and infertility. PCOS patients tend to have higher levels insulin in their blood, making them insulin-resistant and putting them at higher risk of prediabetes or diabetes. As we already know, high insulin levels can lead to acanthosis nigricans. High insulin can also trigger the overproduction of testosterone, which can lead to other skincare problems for patients. In fact, PCOS-related hormone imbalances can manifest in a variety of skin conditions, including hirsutism, acne, female pattern hair loss, seborrhea, striae, and acrochordons.

Courtesy of regionalderm.com.

How do I treat acanthosis nigricans?

It depends. Acanthosis Nigricans itself isn’t actually a disease, but rather, a symptom of another health issue, so treatment depends on the underlying cause. Sometimes, the answer can be as simple as working out or changing your diet. In other cases, adjusting medications or supplements under the guidance of your doctor can do the trick. For PCOS patients, collaboration between an individual’s dermatologist, endocrinologist, gynecologist, nutritionist, and physical trainer was found to be the most effective mode of treatment.

In addition to treating their underlying causes, some acanthosis nigricans patients choose to treat their darkened skin with cosmetic treatments. There are several ingredients — Retin-A, urea, alpha hydroxy acids (AHAs), and BHAs like salicylic acid — that target the discoloration caused by the condition. Other helpful treatments include antibacterial soaps, oral acne medicine, and laser therapies. Cosmetic treatments, and their effectiveness, will vary depending on the severity of the discoloration and underlying condition, so those with acanthosis nigricans should always consult with their dermatologist and other doctors before using products or booking procedures.

The good news is that for many patients, symptoms subside once they address the root cause of their increased insulin production. It’s important to realize that acanthosis nigricans indicates an underlying health problem that you should really address with your doctor, but this health problem is likely related to diet and exercise regimens. Even still, the condition shouldn’t be ignored, as some rare cases are caused by more serious conditions like cancer or PCOS. Even then, early detection is key to recovery and symptom management.

Although sudden changes in your skin and physical appearance can be scary, acanthosis nigricans isn’t something to panic about. If you have concerns about symptoms you may have, consult a dermatologist or gynecologist to rule out more severe causes.

  1. Hi Dr Sandra Lee! … I have PCOS… and I suffer from Acanthosis Nigricans but only between my thigs which really affects my sexual life (i’m 25 years old) …The thing is that I also have suppurative hidradenitis … and some cysts between my things and under my armpit are already black and cystic.. My endocrinologyst gave me metformin and spironolactone and told me those black spots and cystic cysts were going to dissapear… but I think I need a dermatologist to get rid of those cystic cyst that looks incarnated. Am I right? Or should I wait for my body to absorb them?

    I’m from Mexico so I can’t have an appointment witb you (I’m so sad about that)

    But I hope you can give me any suggestion

    Love your good work! ♡

  2. Dear Dr. Sandra Lee,

    First of all, I would like to thank you for taking care of this topic. My skin color is completely white – like a ghost or an Irish girl. But I had always those dark spots on my neck. I called it lovely as my “shit neck” 🙈. Even when I made fun of it, I was so insecure about this. I had my hairs always open so that I could hide my neck. I was at so many doctors and most of them didn’t even know what this was – they never had a patient with this skin condition. Some of them recommended a skin bleaching – other ones said this could cause the complete opposite and that these spots could get even worse. So I bought natural ingredients like licorice or papaya which I read on the internet should help to lighten the skin. Nothing really helped. Finally, I lost over 35kg and the bad skin condition is almost gone. So I guess for most of the people (of course not everyone) the bad habits are the main reasons for this. Anyway, I’m so happy that you have explained it from your medical point of view – since I was a really long time with this issue all by myself an no one was able to give me the answers I needed. I’m sure this post will help a lot of people with the same thing.

    Best wishes from Germany


    1. My daughter has the same issue, and i think the real thing on this is her diet, there is something wrong with her that even tho she doesn’t eat much or eat fast food she is heavy for her height and age. May I ask you how you lost weight

  3. I have a similar problem but it’s not this severe. I take care of it by exfoliating everyday, and waxing when hair grows. However, it’s only in my armpits and it only happens when I use regular deodorant. which has left me using no deodorant now, I try to use baking soda here and there. Any ideas what kind of hyperpigmentation is happening? How can I stop it?

  4. I have a six year old who has a similar look on her neck. She’s also started to have Armpit smell and she’s a little over weight but according to her pediatrician she’s also in the 92 % taller than most 6 year olds. Should I be concerned? Her pediatrician has not mentioned a concern.

  5. Thanks for writing about this. I have AN and have had it since I was a child. I spent years of my life scrubbing and scrubbing and people would make fun of my “dirty neck”. I finally got over it, but still didn’t know what it was called until 2 years ago when a doctor called it by name and my mind was blown. Thanks for bringing awareness to this skin condition!!

  6. My daughter has this problem and we can’t find a doctor to help us resolve it. Is there a dermatologist in the New York area that specializes in this?

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