How to Treat Acanthosis Nigricans: Addressing the Root Cause, Not Just the Skin

Understanding the Most Effective Treatments for Acanthosis Nigricans in Children and Teenagers

Author: Dr. Natalie Hernandez, Pediatric Endocrinologist & Metabolic and Obesity Medicine Specialist

Acanthosis Nigricans Treatment Starts With Treating the Cause

If you've noticed dark, velvety patches of skin on your child's neck, underarms, elbows, or other skin folds, you're probably searching for one answer:

How do I get rid of it?

The answer may surprise you.

Although many creams and skin treatments can improve the appearance of acanthosis nigricans, the most effective treatment usually isn't found in the skincare aisle.

It's found by addressing the underlying metabolic condition causing the skin changes.

For many children and teenagers, acanthosis nigricans is one of the earliest visible signs of insulin resistance.

That makes it much more than a cosmetic concern.

It can be an important clue that the body is beginning to develop changes associated with prediabetes, metabolic dysfunction, PMOS (formerly PCOS), or future Type 2 diabetes.

The encouraging news is that early recognition creates an opportunity for early intervention, and in many children, improvement is absolutely possible.

What Is Acanthosis Nigricans?

Acanthosis nigricans is a skin condition that causes areas of skin to become:

• Darker than the surrounding skin
• Thickened
• Velvety in texture

It most commonly appears on the:

• Back of the neck
• Underarms
• Groin
• Elbows
• Knees
• Knuckles

Parents often mistake these patches for poor hygiene because they don't wash off.

In reality, the discoloration develops beneath the surface of the skin and cannot simply be scrubbed away.

Why Does Acanthosis Nigricans Develop?

In children and adolescents, the most common cause of acanthosis nigricans is insulin resistance. Want to learn more about insulin resistance? Including symptoms, causes and treatments.

When insulin levels remain elevated over time, insulin stimulates growth factor receptors within the skin.

This causes skin cells to multiply more rapidly, producing the thickened, darker appearance characteristic of acanthosis nigricans.

Simply put:

The skin is responding to what's happening inside the body.

That's why treating only the skin often produces disappointing results.

Unless insulin resistance improves, the underlying process continues.

Acanthosis Nigricans Is Often an Early Warning Sign

One of the most important things families should understand is that acanthosis nigricans frequently develops before diabetes.

Rather than indicating diabetes itself, it often signals that the body is becoming less sensitive to insulin.

This creates an opportunity.

Recognizing acanthosis nigricans early allows physicians to evaluate for conditions such as:

• Insulin resistance
• Prediabetes
• Type 2 diabetes
• PMOS (formerly PCOS)
• Metabolic dysfunction-associated steatotic liver disease (MASLD)
• Elevated cholesterol
• High blood pressure

Early identification allows treatment to begin before more serious complications develop.

The Most Effective Acanthosis Nigricans Treatment

The most effective treatment is improving the underlying metabolic health that caused the skin changes in the first place.

While topical treatments may improve the appearance of acanthosis nigricans, lasting improvement often comes from treating the underlying insulin resistance and improving metabolic health.

This is why pediatric endocrinologists often approach acanthosis nigricans very differently than cosmetic skin conditions.

Rather than asking:

"Which cream works best?"

we first ask:

"Why did this develop?"

For many children, improving insulin sensitivity also improves the skin over time.

Lifestyle Changes Remain the First-Line Treatment

Current medical evidence consistently supports lifestyle modification as the foundation of treatment for insulin resistance–related acanthosis nigricans.

Healthy improvements in metabolism may gradually reduce the appearance of the skin changes while also lowering future health risks.

Lifestyle interventions often include:

Improved Nutrition

A balanced eating pattern emphasizing:

• Lean proteins
• Vegetables
• Fruits
• Whole grains
• High-fiber foods
• Reduced sugar-sweetened beverages
• Fewer highly processed foods

helps improve insulin sensitivity over time.

Rather than focusing on restrictive diets, the goal is building sustainable habits that support lifelong metabolic health.

Regular Physical Activity

Exercise helps muscles use glucose more efficiently and improves insulin sensitivity.

Children and teenagers should aim for approximately 60 minutes of physical activity most days of the week, with a combination of aerobic activity and age-appropriate strength-building exercises.

Even small increases in daily movement can improve metabolic health.

Healthy Sleep

Poor sleep contributes to insulin resistance.

Establishing consistent sleep schedules may improve metabolism, appetite regulation, and overall health.

Sustainable Weight Management

Not every child with acanthosis nigricans has obesity.

However, for children carrying excess body weight, gradual improvements in weight often reduce insulin levels and allow the skin to slowly improve.

The goal isn't simply losing weight.

It's improving metabolic health.

That's an important distinction.

Which Creams Actually Work?

Many families understandably want to improve the appearance of acanthosis nigricans while addressing the underlying cause.

Several topical treatments have demonstrated modest improvements in skin texture and pigmentation. It's important to remember, however, that these treatments improve the appearance of the skin, they do not correct the underlying insulin resistance.

Topical Retinoids

Topical retinoids are generally considered the first-line cosmetic treatment for acanthosis nigricans.

Studies in children have shown that both:

• 0.1% adapalene gel
• 0.025% tretinoin cream

can improve hyperpigmentation and skin texture after approximately eight weeks of treatment.

Some children experience mild redness, peeling, or irritation during the first few weeks, which usually improves as the skin adjusts.

Salicylic Acid and Urea Creams

Research has also shown that:

• 10% salicylic acid
• 10% urea cream

can modestly improve skin discoloration and roughness.

These products work by gently exfoliating thickened skin and may be appropriate for some children under the guidance of their healthcare provider.

Ammonium Lactate

Ammonium lactate is another option that may soften thickened skin and is sometimes combined with topical retinoids for additional cosmetic benefit.

Laser Therapy

Laser treatments have been studied in selected patients and may improve skin pigmentation.

However, because laser therapy does not treat the underlying metabolic problem, it is generally considered only for persistent cosmetic concerns after medical causes have been addressed.

Does Metformin Help Treat Acanthosis Nigricans?

Sometimes.

For children and adolescents with insulin resistance, metformin may improve both insulin sensitivity and, over time, the appearance of acanthosis nigricans.

Several studies and case reports have demonstrated meaningful improvement, even complete resolution in some patients, when metformin was combined with sustained lifestyle changes.

However, the evidence is mixed.

Not every study has shown significant improvement in the skin itself.

This highlights an important principle:

Metformin should never be prescribed simply to treat the skin.

Instead, it may be appropriate when a child has insulin resistance, prediabetes, or another medical condition in which improving metabolism is the primary goal.

Can GLP-1 Medications Improve Acanthosis Nigricans?

This is an emerging area of interest.

GLP-1 medications are not approved specifically to treat acanthosis nigricans, and there are currently no large clinical trials demonstrating that they directly improve the skin.

However, because GLP-1 medications may improve:

• Insulin resistance
• Body weight
• Blood sugar regulation
• Overall metabolic health

some patients may notice gradual improvement in acanthosis nigricans as these underlying metabolic conditions improve.

In other words:

GLP-1 medications don't treat the skin directly, they may help improve the metabolic abnormalities that contribute to the skin changes.

When Should Your Child See a Pediatric Endocrinologist?

Because acanthosis nigricans is often associated with insulin resistance, it should never be dismissed as "just a skin problem."

A medical evaluation may be appropriate if your child has:

• Dark, velvety skin on the neck, underarms, or other skin folds
• Rapid weight gain
• A family history of Type 2 diabetes
• Prediabetes
• PMOS (formerly PCOS)
• Elevated cholesterol
• High blood pressure
• Fatty liver disease (MASLD)

Depending on your child's history and physical examination, your physician may recommend laboratory testing such as:

• Hemoglobin A1C
• Fasting glucose
• Lipid panel
• Liver function tests
• Thyroid testing (when appropriate)

Identifying insulin resistance early allows families to begin treatment before more significant metabolic complications develop.

Frequently Asked Questions (FAQ)

Can acanthosis nigricans go away?

Yes.

In many children, acanthosis nigricans improves as insulin resistance and overall metabolic health improve.

The timeline varies from child to child and often depends on the underlying cause.

What is the best cream for acanthosis nigricans?

Topical retinoids, including adapalene and tretinoin, have the strongest evidence for improving the appearance of the skin.

However, creams alone do not treat the underlying cause.

Does washing the skin help?

No.

Acanthosis nigricans is not caused by poor hygiene, and scrubbing the affected areas will not remove the discoloration.

In fact, excessive scrubbing may irritate the skin.

Is acanthosis nigricans always caused by diabetes?

No.

More commonly, it is associated with insulin resistance, which often develops before diabetes.

This is one reason early medical evaluation is so important.

The Bottom Line

The best treatment for acanthosis nigricans isn't simply finding the right cream.

It's identifying and treating the underlying metabolic condition responsible for the skin changes.

For many children, acanthosis nigricans serves as an early warning sign of insulin resistance, offering families an opportunity to intervene before prediabetes or Type 2 diabetes develops.

While topical treatments can improve the skin's appearance, lasting improvement usually comes from healthier metabolism.

Treat the cause.

The skin often follows.

Concerned About Acanthosis Nigricans?

Dark, velvety skin on the neck or underarms may be your child's first visible sign of insulin resistance, not simply a cosmetic concern.

At LIFE Pediatric Endocrinology, Dr. Natalie Hernandez and the Confident Body Program focus on identifying the underlying metabolic causes of acanthosis nigricans and developing personalized treatment plans that support healthier metabolism, improved insulin sensitivity, and long-term wellness.

If you're concerned about insulin resistance, prediabetes, PMOS (formerly PCOS), or unexplained skin changes, schedule a consultation to learn how early evaluation can make a meaningful difference for your child's future health.

About Dr. Natalie Hernandez

Dr. Natalie Hernandez is a pediatric endocrinologist with advanced fellowship training in pediatric obesity medicine, metabolism, diabetes, and hormone health. She specializes in caring for children and adolescents with insulin resistance, prediabetes, PMOS (formerly PCOS), obesity, and other metabolic disorders through compassionate, evidence-based care.

As the physician leader of LIFE Pediatric Endocrinology's Confident Body Program, Dr. Hernandez helps families understand the biological factors driving metabolic disease so they can make informed decisions that support lifelong health—not just temporary improvements.

Medical Disclaimer

The information provided in this article is for educational purposes only and is not intended as medical advice. It should not be used to diagnose or treat any medical condition or replace individualized care from a qualified healthcare professional. Always consult your physician or another licensed healthcare provider regarding questions about your child's health or before starting any new treatment.

References

1. Pediatric Dermatology. Acanthosis Nigricans. 2022.
2. Maguolo A, Maffeis C. Acanthosis Nigricans in Childhood: A Cutaneous Marker That Should Not Be Underestimated, Especially in Obese Children. Acta Paediatrica. 2020.
3. Treesirichod A, et al. Comparison of the Efficacy and Safety of 0.1% Adapalene Gel and 0.025% Tretinoin Cream in the Treatment of Childhood Acanthosis Nigricans. Pediatric Dermatology. 2019.
4. Treesirichod A, et al. A Comparison of 10% Salicylic Acid and 10% Urea Creams in Treating Acanthosis Nigricans in Adolescents. Archives of Dermatological Research. 2023.
5. Coerdt KM, Todd SP, DeKlotz CMC. Topical Rapamycin for Acanthosis Nigricans in Adolescents. Pediatric Dermatology. 2021.
6. Giri D, et al. Acanthosis Nigricans and Its Response to Metformin. Pediatric Dermatology. 2017.
7. Romo A, Benavides S. Treatment Options in Insulin Resistance Obesity-Related Acanthosis Nigricans. The Annals of Pharmacotherapy. 2008.
8. Hermanns-Lê T, Scheen A, Piérard GE. Acanthosis Nigricans Associated With Insulin Resistance: Pathophysiology and Management. American Journal of Clinical Dermatology. 2004.