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Acanthosis – Causes, Symptoms and Treatment

Acanthosis is a thickening of the epidermis caused by excessive proliferation of spinous cells. It is an important histological finding associated with various skin and metabolic conditions.

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Things worth knowing about "Acanthosis"

Acanthosis is a thickening of the epidermis caused by excessive proliferation of spinous cells. It is an important histological finding associated with various skin and metabolic conditions.

What is Acanthosis?

Acanthosis refers to a thickening of the epidermis (the outermost layer of the skin) caused by excessive proliferation and widening of the stratum spinosum, also known as the spinous cell layer or prickle cell layer. The term derives from the Greek word akantha, meaning thorn or spine. Acanthosis is not a disease in itself but rather a histological finding identified through microscopic examination of skin tissue. It can indicate a variety of underlying skin, metabolic, or systemic conditions.

Causes

Acanthosis can result from a wide range of factors and is frequently observed alongside inflammatory, genetic, or metabolic disorders. Common causes include:

Chronic skin inflammation (e.g., psoriasis, eczema, lichen planus)
Mechanical irritation from friction or persistent pressure
Metabolic disorders such as insulin resistance or type 2 diabetes (especially associated with Acanthosis nigricans)
Genetic conditions such as ichthyosis
Medication side effects (e.g., corticosteroids or certain hormonal preparations)
Paraneoplastic reactions, meaning skin changes triggered by internal malignancies

Symptoms and Clinical Presentation

As acanthosis is a histological finding, its outward appearance varies greatly depending on the underlying condition. Common clinical signs include:

Thickening and coarsening of the skin
Scaly or rough skin texture
Hyperpigmentation (darkening of the skin), particularly in Acanthosis nigricans
Itching or burning sensations in the affected areas
Preferential involvement of skin folds (armpits, neck, groin) in Acanthosis nigricans

Acanthosis Nigricans

One of the most well-known subtypes is Acanthosis nigricans, in which the skin in body folds becomes dark, velvety, and thickened. It is an important clinical indicator of underlying insulin resistance, obesity, or -- in rare cases -- an internal malignancy (paraneoplastic syndrome).

Diagnosis

The diagnosis of acanthosis is typically established through:

Clinical examination: Visual and tactile assessment of the affected skin regions by a dermatologist
Skin biopsy with histological analysis: A tissue sample is taken and examined under a microscope to confirm thickening of the spinous cell layer
Laboratory tests: Blood work to investigate metabolic disorders (e.g., blood glucose, insulin levels, hormonal profile)
Further diagnostic workup: If a paraneoplastic cause is suspected, imaging studies such as ultrasound or CT scans may be required

Treatment

Treatment of acanthosis is always directed at the underlying cause. Addressing only the skin thickening without treating the root condition is generally insufficient.

Treatment of the underlying condition: e.g., blood sugar management in diabetes, weight reduction in obesity, or treatment of psoriasis or eczema
Topical therapy: Keratolytic creams (e.g., containing salicylic acid or urea) can help reduce skin thickening
Pharmacological treatment: Retinoids, antiandrogens, or metformin (in insulin resistance) may be prescribed depending on the cause
Regular skin care: Emollient lotions and consistent skin care routines support treatment outcomes

References

Bolognia, J. L., Schaffer, J. V., Cerroni, L. - Dermatology. 4th edition, Elsevier, 2018.
Pschyrembel Clinical Dictionary. De Gruyter, 2023.
World Health Organization (WHO) - Skin conditions and metabolic syndrome overview. WHO Publications, 2021.

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