ACANTHOSIS NIGRICANS
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1)  adapalene gel
2)  worsened by niacin


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			ADAPALENE GEL
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Just had an obese 16 year old woman with a 10 year history of idiopathic
acantosis nigricans come back after 6 weeks of daily or bid application of
Differin (adapalene) gel - greatly improved compared with photos taken 6
weeks ago. She's very pleased and will continue with this. She had not
responded adequately in the past to vitamin A acid cream, and this was
stopped because of irritation.  

Kevin C. Smith MD FRCPC
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Adapalene hasn't been around long, even in Europe. There is not much written
about it other than in vitro and in acne. Anecdotes are sure to proliferate
in the next few mos.

In most diseases I imagine that it'll do about what retinA will do, (but with
perhaps less irritation) since it works  by binding to nuclear RA receptors,
(but bypasses the cellular RA binding proteins).

Guy Webster
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			WORSENED BY NIACIN
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Just saw a patient today with severe Acathosis of his axillae, groin,
antecubital fossae and neck. He is mid 30's and only med taken is niacin for
3 months for high cholesterol. PMD has found no other underlying illness. Any
ideas?

Martin Kay
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I've had two similiar patients recently one cleared with reduction in the dose
of his niacin, the other cleared with retin A 0.05% cream applied once daily.
Interestingly, the latter patient cleared within  a few days of applying the
retin A.  

Brad Becker M.D.
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Niacin is well known to produce acanthosis nigricans.  I have had three cases
in my 17 years of practice.  D/C niacin and the acanthosis resolves
spontaneously.  If it does not, then proceed with w/u for underlying
malignancy.

Jeff Marmelzat, M.D.
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I have recently seen a number of cases of severe acanthosis nigricans.  
Each of these patients were found to have extremely high insulin levels 
indicative of insulin resistance.  Obesity was probably a factor in each 
of these cases.  In one patient, the acanthosis nigricans (and the 
elevated insulin levels) responded remarkably to calorie restriction.

Steve Feldman, MD, PhD
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It's the niacin. Also, check for diabetes or glucose intolerance.

Jerry Eisner
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