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Acanthosis Nigricans in the Armpit[/caption]
The dark discoloration in the skin could be Acanthosis Nigricans (AN). AN is typically a dark raised area and can be velvety. It can show up anywhere in the skin. Common locations are the armpits, the face, elbows, knuckles, back of the neck, chest, and groin.
The reasons for the presence of AN could be cancer, familial, drug-related, and insulin resistance.
AN and Insulin Resistance
Modern life is filled with demands and stress from work and home. By the time someone gets home from the daily grind, binge-watching on the television and munching away on snacks seems like the best way to get relief and just forget everything else.
While that is understandably so, if it becomes a habit, then it can lull someone to a sedentary lifestyle that can result in many chronic diseases. A sedentary lifestyle with a diet of processed food with refined carbohydrates is the ideal recipe for insulin resistance.
Insulin resistance (IR) is when the skeletal muscles and the liver “resists” the action of insulin to accept the circulating glucose in the blood. The skeletal muscles and liver refused because they are still filled with glycogen because of inactivity.
The pancreas then produces more insulin (hyperinsulinemia, HI) to “push” more glucose into the muscle fibers. Insulin resistance and hyperinsulinemia then lead to Type 2 diabetes, metabolic syndrome, obesity, and many other diseases.
Science Behind Acanthosis Nigricans
The excess insulin stimulates growth factors in the blood like an insulin-like growth factor (IGF). IGF can stimulate the skin cells to multiply, which results in the thickening (acanthosis) of the layers of the skin called stratum basale and stratum spinosum (see the photo above). The darkening is due to the thickening of the skin layers and NOT because of increased pigmentation. Finger-like projections (papillomatosis) also form on the superficial layers that give the acanthosis the velvety feel.
Frequent eating also activates the mTORC1, (mammalian target of rapamycin complex 1 or mechanistic target of rapamycin complex 1) to sense the available nutrients and promotes more cellular production that adds to the thickening of the skin.
Treatment Available
There are topical medicines like trichloroacetic acid and salicylic acid that burns the skin and allows new cells to “rejuvenate.” There are also depigmenting creams. However, they do not address the underlying cause (IR & HI), and we know that the darkening is not secondary to hyperpigmentation. The treatment is literally skin-deep.
Other medicines like isotretinoin are also prescribed because they reduce cell proliferation and prevent thickening. Typically, cells are produced in the body regularly for maintenance and repair. Medications like isotretinoin also affect normal cellular production. That is why you have to look hard and long at the side effects before you use it. Among which are birth defects in case you get pregnant while using it.
Diabetes medicines like metformin and rosiglitazone are used for people with insulin resistance. But they do not address the reason why IR & HI started in the first place. Therefore, it only assures continued refill of the drugs and possibly progression to metabolic syndrome and Type 2 diabetes.
Intermittent fasting Reverses Insulin Resistance
Intermittent fasting allows the body to be sensitive again to insulin. From previous articles, it was presented that a vicious cycle forms with IR and HI. As in IR leads to HI and leads to IR etc. Intermittent fasting gives the liver and skeletal muscles a break from the nutrients. The fasting period allows the liver and muscles to use the stored glycogen to make room for glucose entry after the next meal. This results in a lower insulin level and burning off the excess fat. The excess fat inside the abdomen are well known to cause body-wide inflammation.
The lesser the insulin, the less stimulus for excessive cell production. A period of low or no nutrient intake also directs the mTORC1 to stop producing excessive cells. If physical activity is increased or exercise is added to the weight loss program, then the process of reversing IR and HI becomes faster. AN may take several weeks or months to go away. Studies have shown that fasting and exercise can help with the other diseases associated with the metabolic syndrome.
So next time you see a dark armpit, do more than just applying something to make it go away. Think about insulin resistance and see your doctor.
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Thanks for reading!
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References:
- Barbato, Mariana Tremel, Criado, Paulo Ricardo, Silva, Ana Kris da, Averbeck, Evelyne, Guerine, Marina Bensen, & Sá, Naiana Bittencourt de. (2012). Association of acanthosis nigricans and skin tags with insulin resistance. Anais Brasileiros de Dermatologia, 87(1), 97-104. https://dx.doi.org/10.1590/S0365-05962012000100012
- Higgins et al., Acanthosis Nigricans: A practical approach to evaluation and management. Dermatology Online Journal 14 (9): 2
- Napolitano et al., Insulin Resistance, and Skin Diseases. The Scientific World Journal
Volume 2015, Article ID 479354
Photo Credits:
- Acanthosis Nigricans on the axilla By Madhero88 – http://www.dermnet.com/Acanthosis-Nigricans/picture/22985, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9710451
- Neck acanthosis from An. Bras. Dermatol. vol.87 no.1 Rio de Janeiro Jan./Feb. 2012
- Microscopic layers of the skin By Mikael Häggström, based on work by Wbensmith – File: WVSOM Meissner’s corpuslce.JPG by Wbensmith.Layers were drawn according to image at Home Page of Deborah S. Dempsey, Department of Biological SciencesNorthern Kentucky University > V. SKIN > 2 LAYERS ([1]), CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10759398
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